[Pituitary hemorrhage extending into the third ventricle. Case report]

Area of Science:

• Neuroendocrinology
• Neuropathology

Background:

• Pituitary apoplexy is a clinical syndrome characterized by sudden onset of severe headache, visual impairment, and ophthalmoplegia, often associated with pituitary hemorrhage or infarction.
• It is a rare but potentially life-threatening endocrine emergency requiring prompt diagnosis and management.

Observation:

• A 73-year-old obese female presented with sudden vomiting and impaired consciousness, stupor, neck stiffness, and a dilated left pupil.
• Skull X-ray revealed sellar enlargement and dorsum sellae destruction; CT showed a high-density mass in the suprasellar cistern and ventricles.

Findings:

• Autopsy confirmed a large sellar/suprasellar basophilic adenoma with significant hemorrhage.
• The hematoma extended into the third ventricle, compressing the hypothalamic region and third ventricular floor.
• Histology revealed pituitary hemorrhage secondary to ischemic necrosis within the adenoma due to acute expansion.

Implications:

• This case underscores the critical risk of third ventricular extension in pituitary apoplexy due to large adenomas.
• Effective management of pituitary adenomas is crucial to prevent catastrophic complications like pituitary hemorrhage.
• Understanding the mechanisms of hemorrhage extension is vital for predicting patient outcomes and guiding treatment strategies.