Pituitary apoplexy
It is an acute clinical syndrome with headache, visual defects/ophthalmoplegia, altered mental status, variable endocrine deficiencies caused by either hemorrhage or infarction of pituitary gland.
Pre-existing pituitary macroadenoma common.
Imaging findings
CT Findings
- Acute
- Sellar/suprasellar mass with patchy or confluent hyperdensity
- May be associated with subarachnoid hemorrhage .
- Chronic: \"Empty\" sella.
- Rim-enhancement in a \"snowman\" shaped sellar/suprasellar mass is highly suggestive of pituitary apoplexy.
MR Findings
- T1WI
- Early acute: Enlarged gland, iso/hypointense with brain
- Late acute/subacute: Hyperintense
- Chronic: Hypointense
- \"Empty\" sella (filled with CSF)
- T2WI
- Acute
- Enlarged, hypointense (hemorrhagic) or hyperintense (nonhemorrhagic) pituitary
- Subacute: Hyperintense
- Chronic: Hyperintense (\"empty\" sella filled with CSF)
- Acute
Treatment
Early diagnosis, treatment of acute Pituitary apoplexy necessary to prevent morbidity/mortality. Surgical decompression is the treatment of choice.