Pituitary Histopathology in Fatal Heroin Intoxication, Suicidal Hanging, and Sudden Cardiac Death: An Exploratory Retrospective Autopsy Study

Background/Objectives: The pituitary gland is highly susceptible to hypoxic–ischemic injury because of its distinctive vascular architecture, yet its forensic significance in non-traumatic deaths remains poorly defined. This study aimed to compare pituitary histopathology across deaths caused by different mechanisms of systemic hypoxia. Methods: This retrospective observational study investigated pituitary histopathology in 30 forensic autopsies performed between 2019 and 2025, including suicidal hanging (n = 10), fatal heroin intoxication with respiratory failure (n = 10), and sudden cardiac death controls (n = 10). Hematoxylin–eosin-stained sections were systematically evaluated for hemorrhagic, ischemic, and necrotic changes and their anatomical distribution. Results: Neurohypophyseal hemorrhage was detected in 6/10 hanging cases and 8/10 heroin-related deaths, but in no controls. Adenohypophyseal ischemic–necrotic lesions occurred in 2/10 hanging cases and 6/10 heroin cases and were absent in controls. Lesions were generally more extensive in heroin intoxication, where hemorrhage often coexisted with vascular congestion and coagulative necrosis. The preferential involvement of the posterior lobe by hemorrhage and the anterior lobe by ischemic–necrotic injury is consistent with their different vascular supplies. Conclusions: These exploratory findings require validation. Hypoxia duration and residual perfusion were not measured. Pituitary sampling may be a complementary tool worth investigating in selected forensic cases; its routine utility was not assessed. Because all sections were stained with hematoxylin–eosin only, these findings are preliminary and require confirmation.