Clinically asymptomatic pituitary adenoma manifesting as pituitary apoplexy and fatal third-ventricular hemorrhage

A 56-year-old woman with an asymptomatic pituitary adenoma had a fatal third-ventricular hemorrhage of sudden onset. A suprasellar mass with hemorrhage and rupture into the third ventricle was found at autopsy. Histologically, the tumor cells from the suprasellar mass and the third-ventricular hemorrhage were diagnostic of a pituitary adenoma. The pathogenesis of the third-ventricular hemorrhage from a pituitary adenoma and the need to consider pituitary apoplexy in the differential diagnosis of third-ventricular hemorrhage are discussed. On the basis of a review of the literature, it is felt that computerized tomographic scanning, although most helpful in diagnosis of sellar lesions, does not replace skull radiographs and sellar tomography in the investigation of suspected pituitary apoplexy.