A recent case report describes a patient whose sudden vision loss led to the diagnosis of pituitary apoplexy, a rare endocrine emergency that can cause severe neurological and visual complications.
Pituitary apoplexy occurs when hemorrhage or infarction develops in the pituitary gland, most often in the presence of a pituitary adenoma. The condition can produce acute neurological, ophthalmologic, and endocrine symptoms, including severe headache, visual impairment, vomiting, and altered consciousness.
Researchers reported the case of a 56-year-old woman who presented with acute visual loss after several years of worsening symptoms. The patient had experienced blurred vision for approximately three years and worsening headaches for more than two years. Imaging performed earlier had revealed a pituitary adenoma measuring about 3 × 2 cm, and she had been referred for neurosurgical evaluation but did not pursue follow-up care.
One week before presentation, the patient developed sudden vision loss accompanied by projectile vomiting. On examination, vital signs were stable, but confrontation visual field testing revealed bitemporal hemianopia.
Computed tomography of the head showed a cystic mass in the sella turcica measuring approximately 4.6 × 2.7 cm with an enhancing rim and compression of the optic chiasm. The findings were consistent with pituitary apoplexy associated with the known pituitary adenoma.
Formal visual field testing confirmed severe visual impairment. The patient had no light perception in the left eye, while the right eye showed temporal visual field loss. Optical coherence tomography findings were consistent with optic nerve damage related to the sellar mass.
The patient was started on oral prednisolone 60 mg daily. Although her headaches improved, the visual deficits persisted. On the third hospital day, her systolic blood pressure dropped below 100 mm Hg, and clinicians initiated fludrocortisone therapy.
She subsequently underwent endoscopic transsphenoidal resection of the pituitary tumor. Surgeons identified hemorrhagic tumor contents and removed the fibrous capsule. Histopathologic examination confirmed pituitary adenoma.
Postoperatively, the patient experienced partial visual recovery. Within two days, vision in the right eye improved to the ability to count fingers, although vision in the left eye did not recover.
Follow-up endocrine testing showed improvement in thyroid function parameters, while adrenocorticotropic hormone levels remained low. Cortisol levels remained within the normal range.
Pituitary apoplexy is considered a medical emergency. Previous studies have reported mortality rates ranging from 0% to 15.3%, particularly when diagnosis and treatment are delayed.
The researchers noted that patients with headaches accompanied by impaired visual acuity or visual field defects should be evaluated for possible pituitary adenoma. In patients with known pituitary adenoma, the sudden onset of severe headache or visual field loss should raise concern for pituitary apoplexy and prompt urgent imaging and multidisciplinary management.
The researchers reported no conflicts of interest.
Source: Clinical Case Reports
