Pituitary apoplexy and severe bilateral visual loss: a case report

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies. We present a case report and a review of the literature. Case-report. - We report the case of a 31-year-old man who neglected bitemporal visual toss (less than 1/10 OD and 2/10 OS). Emergency cerebral tomodensitometry found a pituitary apoplexy. Visual field loss was nearly complete at OD and temporal hemianopia was present at OS. These ocular complications led to a neurosurgical transsphenoidal resection of the necrotic adenoma. Follow-up was satisfactory with complete recovery of visual acuity and visual field. Discussion. - In the literature, headaches are present in 76% of the patients, visual toss in 62%, and ocular motor nerve palsy in 40%. Third cranial. nerve palsies are predominant. Conclusion. - The clinical picture of pituitary apoplexy is characterized by the sudden onset of oculomotor palsy or blindness with acute headaches and even consciousness impairment. A functional and vital risk is present because of acute hypopituitarism. This emergency diagnosis is confirmed by tomodensitometry or magnetic resonance imaging. The association of hormone substitution and tumor transsphenoidal resection commonly leads to a positive outcome and visual improvement. (C) 2009 Elsevier Masson SAS. All rights reserved.