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Pituitary Apoplexy Masquerading as Intractable Headache in a 66-Year-Old Man: A Case Report
Ashley Heaney1, Negin Ceraolo1, Erin L Simon1
1Department of Emergency Medicine, Cleveland Clinic Akron General, Northeast Ohio Medical University, Akron, Ohio.
The Journal of Emergency Medicine
|November 1, 2025
Summary
Pituitary apoplexy, a rare endocrine emergency, presents diagnostic challenges. Early advanced imaging and endocrine consultation are crucial for timely diagnosis and management of this serious condition.
Area of Science:
- Endocrinology
- Neurology
- Emergency Medicine
Background:
- Pituitary apoplexy is a rare, life-threatening endocrine emergency.
- It results from pituitary gland hemorrhage or infarction, often with a preexisting adenoma.
- It frequently mimics other neurological conditions, delaying diagnosis.
Purpose of the Study:
- To highlight the diagnostic complexity of pituitary apoplexy.
- To emphasize the need for advanced imaging and early endocrine consultation in headache syndromes.
- To inform emergency physicians about recognizing pituitary apoplexy.
Main Methods:
- Case report of a 66-year-old man with recurrent headaches.
- Initial noncontrast CT was normal; subsequent imaging revealed a pituitary macroadenoma.
- Cerebrospinal fluid analysis showed pleocytosis, initially raising concern for meningitis.
Main Results:
- The clinical context supported chemical meningitis secondary to pituitary apoplexy.
- Normal initial CT imaging did not exclude the diagnosis.
- Evolving symptoms and CSF abnormalities mimicked meningitis but were likely sterile.
Conclusions:
- Pituitary apoplexy presents diagnostic challenges, especially with nondiagnostic initial imaging.
- Emergency physicians should suspect pituitary apoplexy in severe or recurrent headaches.
- Early recognition, corticosteroid therapy, and multidisciplinary care are vital for preventing deficits.
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