Pituitary apoplexy complicating chronic secondary amenorrhea

Three young women who developed amenorrhea secondary to large, unsuspected pituitary tumors are described. They presented with acute onset of the triad of headache, nausea and vomiting, and visual abnormalities. One patient died; the other two retained some sequelae, and one had a significant hemiparesis. These devastating effects of pituitary apoplexy can be avoided in amenorrheic patients if the possibility of a pituitary tumor is considered early on. Lateral skull x-ray examinations are inexpensive an easily obtained and will usually demonstrate significant pituitary tumors. Early recognition and surgical removal of pituitary tumors carries low morbidity and mortality and will avoid an apoplectic crisis.