More Than a Headache: Unveiling Pituitary Apoplexy Following Acute Coronary Syndrome

Pituitary apoplexy (PA) is an endocrine emergency characterized by ischemia or hemorrhage of the pituitary gland. The main symptom is a sudden and severe headache, often accompanied by ocular palsies and visual field defects. Recognized risk factors include anticoagulation, hypertension, obesity, and major surgical procedures. A 72-year-old man with a history of partially resected pituitary macroadenoma was admitted for an acute coronary syndrome. Anticoagulant and antiplatelet therapy were initiated, and he was awaiting coronary artery bypass grafting (CABG). He experienced a sudden headache accompanied by palsies of the left third and sixth cranial nerves. An initial computed tomography (CT) scan revealed no remarkable findings; however, due to high clinical suspicion of PA, hydrocortisone treatment was initiated, and anticoagulation therapy was discontinued. No new hormonal deficits were observed. Subsequently, magnetic resonance imaging (MRI) confirmed the diagnosis. Following a multidisciplinary consultation, a conservative management strategy was adopted. The patient's symptoms gradually subsided, and he successfully underwent CABG. This case highlights the limited sensitivity of CT scan, emphasizing MRI as the gold standard for diagnosis. The patient's acute coronary syndrome likely triggered the event, not only due to the antithrombotic therapy used but also through shared risk factors such as obesity. Although many patients require surgical intervention, certain cases may be managed effectively through conservative measures. This case demonstrates a successful outcome with a conservative approach, a strategy suitable for clinically stable patients who do not have severe or worsening visual deficits.