Apoplexy in pituitary macroadenoma presenting with total ophthalmoplegia and preserved vision: A rare entity

An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

“…[7] This entity usually manifests with ocular palsy, visual field and visual acuity disturbances, nausea, vomiting, photophobia and hypertension. [1][2][3][4][5][6][7][8][9] Apoplexy may be encountered in patients with a rapidly growing pituitary adenoma, not identified until the development of symptoms related to the former. [9] A wide range of risk factors for the development of pituitary apoplexy have been reported in the literature, with poorly controlled arterial hypertension often identified as the culprit.…”

“…[1][2][3][4][5][6][7][8][9] Apoplexy may be encountered in patients with a rapidly growing pituitary adenoma, not identified until the development of symptoms related to the former. [9] A wide range of risk factors for the development of pituitary apoplexy have been reported in the literature, with poorly controlled arterial hypertension often identified as the culprit. [1,4,5,8] Other potential precipitating factors include pituitary irradiation, major surgery, coagulopathies, head trauma, pregnancy, dynamic pituitary gland studies, and hormone replacement therapy, among others.…”

“…Hypertension induced degenerative microvasculature alterations are known to precipitate apoplectic episodes. [1][2][3][4][5][6][7][8][9] The clinical features are quite variable. [7] Literature suggest the most commonly identified early manifestation is retro-orbital headache, as a result of stretching and irritation of the dura mater overlying the sella turcica.…”