Abstract
Pituitary apoplexy is a clinical syndrome of hemorrhage or infarction of a pituitary adenoma. It has classically been associated with pituitary macroadenomas. The authors report three cases of pituitary apoplexy that occurred in patients with pituitary microadenomas. The presentation, endocrine results, and radiological and clinical outcome of each patient are described. In each of these cases of pituitary apoplexy due to microadenoma, the presenting headache was mistakenly attributed to a different diagnosis. The authors propose that pituitary apoplexy associated with a microadenoma may be much more common than appreciated and could be misdiagnosed as headache of alternative cause. Clinicians and radiologists should be aware of this clinical presentation.
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References
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Acknowledgments
The authors thank Kristin Kraus, M.Sc., for editorial assistance preparing this paper.
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The authors do not report any conflict of interest concerning the cases outlined in the paper.
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Comment
This straightforward presentation of three cases of pituitary apoplexy in microadenomas encourages rethinking of patients during the daily work. Headaches with sudden onset in young women demand to rule out subarachnoid hemorrhage, but hemorrhage into another compartment of the skull is also a differential diagnosis. Hypopituitarism may develop in these patients. Minor deficits may only be detected in the blood workup and not present with clinical signs.
Jens Lehmberg
Munich, Germany
A timely reminder that small pituitary lesions can undergo apoplexy.
Michael Powell
London, UK
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Randall, B.R., Couldwell, W.T. Apoplexy in pituitary microadenomas. Acta Neurochir 152, 1737–1740 (2010). https://doi.org/10.1007/s00701-010-0706-6
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DOI: https://doi.org/10.1007/s00701-010-0706-6