[Stress-induced pituitary apoplexy in 2 phases]

A case of pituitary apoplexy occurring in the context of physical effort is reported. A 47-year-old man presented headache after a foot-race. Secondary visual deficit developed. On admission, bilateral cavernous sinus syndrome with bitemporal hemianopia was observed. The CT scan showed an enlarged sella eroded by an intrasellar soft tissue mass. Magnetic resonance imaging (MRI) confirmed the presence of the mass with peripheral enhancement following gadolinium injection. Decompression was carried out by transsphenoidal surgery. The microscopic study demonstrated infarction of the anterior hypophysis with peripheral tissular scarring. The post-operative outcome was characterized by visual recovery and anterior hypophyseal insufficiency. The possible pathophysiological mechanisms are discussed.