A Case of Ischemic Pituitary Apoplexy Secondary to ACTH-Secreting Macroadenoma

Background: Pituitary apoplexy (PA) represents a rare but extremely serious complication of pituitary adenoma. It is characterized by the rapid onset of headache, nausea and vomiting, changes in vision, paralysis of the oculomotor nerves and alteration of the sensory. Due to the rarity of this complication and the non-specificity of symptoms, the patient’s clinical presentation may not be interpreted correctly, leading to a diagnostic delay and a worsening of prognosis. Case Description: This case report relates to a 73-year-old man with ACTH-secreting macroadenoma infiltrating the cavernous sinuses bilaterally and causing the rapid onset of headache, bilateral eyelid ptosis, complete bilaterally ophthalmoplegia and bitemporal hemianopia. The patient underwent urgent surgery to remove the lesion by transsphenoidal route and subsequent monitoring of pituitary function by endocrinologist specialist obtaining a near-total recovery from illness. Conclusions: PA is often characterized by the appearance of unilateral ocular or neurological deficits, while a clinical presentation given by ophthalmoplegia and bilateral ptosis is a very rare condition, difficult to find in the literature. Therefore, similar symptoms should not be underestimated and should raise the diagnostic suspicion of PA. In this case, in fact, a prompt treatment and multidisciplinary management of the patient allowed to markedly improve the prognosis. Furthermore, the instrumental findings supported a picture of ischemic pituitary apoplexy without signs of haemorrhage, a condition reported only sporadically in the literature.