Acute stroke in pituitary adenomas complicated by pituitary apoplexy

Pituitary apoplexy is a clinical syndrome that is manifested by headache, visual disturbances, ophthalmoplegia or impaired consciousness. It can develop as a result of necrosis or hemorrhage in the pituitary gland or in cases of pituitary tumors. A favorable prognosis is possible if early diagnosis and timely surgical treatment. Pituitary apoplexy complicated by the disorder of the cerebral circulation occurs relatively rare. We observed the female patient aged of 51 year with pituitary adenoma, clinical signs of which were sudden depression of consciousness, right hemiparesis and left-sided ptosis. Signs of pituitary apoplexy were revealed after performed examinations. The sharp increase in the size of the tumor resulted in a compression of supraclinoid portion of the left internal carotid artery, which was the cause of ischemic brain damage in the pool left middle cerebral artery. After 2 weeks of conservative treatment, the patient was undergone to the surgery via transsphenoidal access. Histological examination confirmed the hemorrhage and necrosis of the pituitary adenoma. Complication developed 3 months after surgery partially regressed. Taking into account the relatively rare occurrence of pituitary apoplexy complicated with cerebrovascular ischemic type, clinicians should be alert to this complication. The method of choice is transsphenoidal delayed adenomectomy with conservative therapy.

pituitary apoplexy, vasospasm, cerebral ischemia, internal carotid artery