Thunderclap headache caused by a pituitary non-functioning tumour presenting as spontaneous pituitary apoplexy

Abstract

Hemorrhagic or ischemic pituitary apoplexy is a rare neuro-endocrine emergency, potentially leading to coma. Neuro-ophthalmic symptoms or complications are amongst the most prevalent clinical features at onset, especially in previously asymptomatic patients. Usually, permanent pituitary insufficiency of various degrees follows, implying long-term hormone substitutive therapy. Rarely, the association of pituitary apoplexy with diabetes insipidus has been noticed. We report the case of a young, apparently healthy 32-year-old man presenting with thunderclap headache, fever, optic chiasm compression, central diabetes insipidus and central thyro-gonadic insufficiency. Magnetic resonance imaging and neurosurgery revealed a clinically non-functioning macro-adenoma developing pituitary hemorrhage. One year after the apoplectic episode, complete recovery of diabetes insipidus and pituitary function was confirmed.

Keywords

• thunderclap headache
• pituitary apoplexy
• pituitary tumour
• transsphenoidal surgery
• magnetic resonance imaging