Pituitary Apoplexy: A Case Series

Pituitary apoplexy (PA) is a rare but potentially life-threatening endocrine emergency, typically resulting from sudden-onset haemorrhage within the pituitary gland. If not promptly diagnosed and managed, it can lead to severe hormonal disturbances and neuro-ophthalmic complications with fatal consequences. Early recognition is crucial for improving patient outcomes. Certain conditions increase susceptibility to PA, including pre-existing pituitary adenomas (most commonly non-functioning), the postpartum period, diabetes mellitus, hypertension, sickle cell anaemia, and acute shock. Here, we describe five cases of PA, each with varied signs and symptoms, which underscores the clinical heterogeneity with which pituitary apoplexies can present. The first and second patients exhibited significant pituitary dysfunction and hyponatremia, necessitating steroid replacement and supportive care, leading to gradual recovery. The third patient presented with an incidental MRI finding of pituitary haemorrhage and remained hemodynamically stable without any evidence of hypopituitarism. The fourth case presented with cranial nerve palsies, while the fifth case, which presented as a prolactinoma, had apoplexy after starting cabergoline therapy. A high index of suspicion is essential for timely diagnosis. Emergency magnetic resonance imaging (MRI) of the sellar region is the gold standard for confirming the diagnosis. Rapid intervention, including appropriate hormonal replacement and neurosurgical evaluation, can be life-saving. This case series highlights the diverse clinical presentations of PA and outlines a structured approach to its management.