ABSTRACT Introduction: Pituitary apoplexy is an ischemic or hemorrhagic rearrangement within a pituitary adenoma. Pituitary apoplexy is a rare disease that constitutes a diagnosis and therapeutic emergency. Most of the time, apoplexy is the manifestation inaugural of an adenoma unknown, but it can also complicate a known adenoma. All adenomas can be concerned with the occurrence of apoplexy, with an equivalent risk, whether they are secreting or not and whatever the type of secretion. We report the case of a patient in whom the cranio-encephalic MRI enabled to make the diagnosis. Observation: A 57-years-old woman abruptly presented severe cephalodynia, followed by a left visual field defect. The clinical examination revealed an alteration of the consciousness to the type of obstruction and a decrease in left visual acuity is 4/10th. The cranio-encephalic MRI performed revealed an expansive intrasellar process with suprasellar extension of heterogeneous signal on all the sequences performed alternating hemorrhagic stigmata in the central tumor zone suggesting a macroadenoma having bled, compatible with pituitary apoplexy. She received medical treatment and hormonotherapy, followed by surgical excision. The outcome was satisfactory. Conclusion: Pituitary apoplexy is a rare but serious complication of pituitary adenomas. It is responsible for various neuro-ophthalmologic. Pituitary apoplexy involves the patient’s functional and vital prognosis due to acute panhypopituitarism. It is a diagnostic and therapeutic emergency. MRI is a major contribution to diagnosis. Treatment is based on the combination of hormone replacement therapy and trans-sphenoidal tumor excision.
Cite this paper
Acko-Ohui, E. , Garba, I. , Setchéou, A. , Acko, U. , Konan, A. and Yapo, P. (2018) Pituitary Apoplexy: A MRI Finding Case and Literature Review. Open Journal of Radiology, 8, 13-21. doi: 10.4236/ojrad.2018.81002.
 Lath, R. and Rajshekhar, V. (2001) Massive Cerebral Infarction as a Feature of Pituitary Apoplexy. Neurology India, 49, 191-193.
 Arafah, B.M., Taylor, H.C., Salazar, R., Saadi, H. and Selman, W.R. (1989) Apoplexy of a Pituitary Adenoma after Dynamic Testing with Gonadotropin-Releasing Hormone. The American Journal of Medicine, 87, 103-105. https://doi.org/10.1016/S0002-9343(89)80494-2
 Galland, F., Vantyghem, M.C., Cazabat, L., Boulin, A., Cotton, F., Bonneville, J.F., Jouanneau, E., Vidal-Trécan, G. and Chanson, P. (2015) Management of Non Functioning Pituitary Incidentaloma. Annales D’Endocrinologie (Paris), 76, 191-200. https://doi.org/10.1016/j.ando.2015.04.004
 Möeller-Goede, D.L., Brändle, M., Landau, K., Bernays, R.L. and Schmid, C. (2011) Pituitary Apoplexy: Re-Evaluation of Risk Factors for Bleeding into Pituitary Adenomas and Impact on Outcome. European Journal of Endocrinology, 164, 37-43. https://doi.org/10.1530/EJE-10-0651
 Akutsu, H., Noguchi, S., Tsunoda, T., Sasaki, M. and Matsumura, A. (2004) Cerebral Infarction Following Pituitary Apoplexy—Case Report. Neurologia Medico-Chirurgica (Tokyo), 44, 479-483. https://doi.org/10.2176/nmc.44.479
 Sibal, L., Ball, S.G., Connolly, V., James, R.A., Kane, P., Kelly, W.F., et al. (2004) Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases. Pituitary, 7, 157-163. https://doi.org/10.1007/s11102-005-1050-3
 Biousse, V. and Makki, A. (2005) Pituitary Apoplexy. Revue Neurologique (Paris), 161, 587-589. https://doi.org/10.1016/S0035-3787(05)85095-7
 Yang, S., Lee, K., Lee, K., Lee, S. and Hong, Y. (2008) Pituitary Apoplexy Producing Internal Carotid Artery Compression: A Case Report. Journal of Korean Medical Science, 23, 1113-1117. https://doi.org/10.3346/jkms.2008.23.6.1113
 Jeon, B., Park, Y., Oh, H., Kim, Y. and Chun, B. (2007) Pituitary Apoplexy Complicated by Chemical Meningitis and Cerebral Infarction. Journal of Korean Medical Science, 22, 1085-1089. https://doi.org/10.3346/jkms.2007.22.6.1085
 Brougham, M., Heusner, A.P. and Adams, R.D. (1950) Acute Degenerative Changes in Adenomas of the Pituitary Body—With Special Reference to Pituitary Apoplexy. Journal of Neurosurgery, 7, 421-439. https://doi.org/10.3171/jns.1950.7.5.0421
 Pozzati, E., Frank, G., Nasi, M. and Giuliani, G. (1987) Pituitary Apoplexy, Bilateral Carotid Vasospasm, and Cerebral Infarction in a 15-Year-Old Boy. Neurosurgery, 20, 56-59. https://doi.org/10.1227/00006123-198701000-00015
 McFadzean, R.M., Doyle, D., Rampling, R., Teasdale, E. and Teasdale, G. (1999) Pituitary Apoplexy and Its Effect on Vision. Neurosurgery, 9, 669-676.
 Bruce, B.B., Biousse, V. and Newman, N.J. (2007) Third Nerve Palsies. Seminars in Neurology, 27, 257-268. https://doi.org/10.1055/s-2007-979681
 Milazzo, S., Toussaint, P., Proust, F., Touzet, G. and Malthieu, D. (1996) Ophthalmologic Aspects of Pituitary Apoplexy. European Journal of Ophthalmology, 6, 69-73.
 Rolih, C.A. and Ober, K.P. (1993) Pituitary Apoplexy. Endocrinology Metabolism Clinics of North America, 22, 291-302.