An exceptional presentation of pituitary apoplexy in thyrotoxicosis

Abstract

Pituitary apoplexy (PA) is a rare and potentially life-threatening condition characterized by severe headaches, vomiting, visual disturbances, ophthalmoplegia, altered mental status, and possible pan-hypopituitarism. A macroadenoma-induced pituitary haemorrhage is the primary cause. Various factors such as systemic hypertension, altered intracranial pressure, head trauma, anticoagulation, and pregnancy can trigger PA. A 35-year-old non-smoking male presented with headaches and an enlarged thyroid gland. Initial imaging revealed a haemorrhage in the sellar area, prompting a clinical diagnosis of pituitary apoplexy with T3 thyrotoxicosis. Despite the absence of visual impairment, conservative management was chosen, including anti-hypertensive therapy and follow-up MRI after three months. PA diagnosis can be challenging without prior identification of a pituitary tumour. Imaging modalities like MRI are crucial for diagnosis, and radiological follow-up is recommended. The relationship between PA and hyperthyroidism remains unclear, necessitating further investigation in patients presenting with PA symptoms.

Keywords

• pituitary apoplexy
• pituitary haemorrhage
• hyperthyroidism
• diagnosis
• management