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Updated: May 21, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Cushing's disease presenting with pituitary apoplexy
Daniel Chan1, Teo Cheng Rong, Rinkoo Dalan
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Pituitary tumour apoplexy, a rare condition, can manifest in Cushing's disease patients with symptoms like severe headache and nerve palsy. This case highlights the critical need for prompt diagnosis and management of such emergencies.
Area of Science:
- Endocrinology
- Neurology
- Neurosurgery
Background:
- Cushing's disease, characterized by excess cortisol, typically presents with specific clinical signs.
- Pituitary tumour apoplexy is a rare, emergent complication involving sudden hemorrhage or infarction of a pituitary adenoma.
Observation:
- A 30-year-old male with Cushing's disease experienced sudden severe headache and right third nerve palsy.
- Magnetic Resonance Imaging (MRI) confirmed a pituitary adenoma with signs of infarction, indicative of apoplexy.
Findings:
- The patient underwent transsphenoidal surgery for the pituitary adenoma.
- Post-operatively, he developed pan-hypopituitarism and diabetes insipidus, indicating extensive pituitary damage.
Implications:
- This case underscores the potential for pituitary apoplexy in Cushing's disease, presenting atypically.
- Early recognition and surgical intervention are crucial for managing pituitary apoplexy, though complications like hypopituitarism may occur.
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