Emergency diagnosis of pituitary apoplexy

A 60-year-old man, chronically anticoagulated for a prosthetic heart valve, suffered visual loss from hemorrhage into an unsuspected pituitary tumor. The diagnosis of pituitary apoplexy was made in the emergency department. The patient's coagulopathy was reversed, and he underwent an uneventful transsphenoidal hypophysectomy. Marked recovery of vision occurred over the next six months. The clinical features of this uncommonly diagnosed syndrome are reviewed, and the importance of recognizing this entity with the advent of computed tomographic scanning is emphasized.