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A 75 year old woman, with a history of trans-sphenoidal hypophysectomy for a non-secreting pituitary adenoma 15 years ago and currently on glucocorticoid and thyroid hormone replacement, was found unconscious on the floor. On arrival to the hospital she was tachycardic and hypotensive. Stress doses of glucocorticoids were given, resulting in normalisation of her blood pressure. Magnetic resonance imaging of the brain showed a 3 × 2 × 2 cm pituitary macroadenoma with bleeding in the centre (figs 1 and 2). The patient was transferred to the neurosurgical service for further observation.
Pituitary apoplexy is a life threatening condition which requires prompt diagnosis and treatment. Usually it occurs in macroadenomas when the tumour outstrips its blood supply. This case shows that apoplexy can occur and should be suspected even in a patient with a previous history of hypophysectomy.