Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Pituitary apoplexy (PA) is a rare serious and potentially fatal medical emergency with a vast spectrum of clinical manifestations. Most frequent symptom is sudden onset of severe retro-orbital headache (90–97%) (1-5). That is why PA is not often suspected initially because of similar presentation of more frequent diseases such as subarachnoid hemorrhage (SAH), cervical artery dissection or cerebral dural sinus thrombosis (6). The second most common symptom is the vision deficit (50% to 82%) (6-9). Other symptoms/signs include diminished consciousness and pan hypopituitarism (80%), nausea, vomiting, ophthalmoplegia and meningism (25–50%) (3,7,8). Pre-existing macro adenoma (65–90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or micro adenoma (9-11)