Pituitary apoplexy in the emergency room: A prior history of pituitary adenoma may not be necessarily present!

Pituitary apoplexy is a rare but life-threatening medical emergency that results from either a sudden hemorrhage or infarction in a pituitary tumor. Unrecognized pituitary apoplexy can lead to serious hormonal and neuro-ophthalmic complications and even death. A major challenge in the diagnosis of pituitary apoplexy is that majority of such patients don't have a prior diagnosis of pituitary adenoma. Emergency magnetic resonance imaging of the pituitary gland is the diagnostic tool of choice for this condition. This may not be readily available in many emergency rooms. A previously healthy patient who presented with sudden severe headache and confusion and was found to have pituitary apoplexy is described and a focused review of the condition is given with emphasis on early recognition and complications of this condition