Apoplexy in a Metastatic Pituitary Mass: A Rare Occurrence

Abstract

Pituitary apoplexy resulting from metastatic disease is an uncommon and rapidly progressive clinical presentation. This report details the case of a gentleman who presented with episodic severe headaches, a unilateral third nerve palsy, and progressive visual field loss. Initial blood tests indicated an abnormal pituitary
hormone profile, while MRI imaging revealed a sellar mass exhibiting features consistent with apoplexy. Due to the acute threat to his vision, an urgent review was conducted at a pituitary multidisciplinary meeting, leading to endoscopic transsphenoidal decompression. The patient had a prior history of colorectal cancer, treated 18 months earlier and previously regarded as in remission. Subsequent histological analysis confirmed that the pituitary lesion was a metastasis from colorectal cancer. This case illustrates the diagnostic and therapeutic complexities inherent in managing this rare presentation.