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Peer-reviewedCC BY-NC-NDJournal of neurosurgery. Case lessons

Multiply recurrent pituitary apoplexy treated nonsurgically: illustrative case.

  • Alexander P Landry1,2
  • Maíra Cristina Velho3
  • Luma Ghalib4,5
  • Daniel M Prevedello4,6
6 affiliations
  1. 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario.
  2. 2Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
  3. 3Department of Neurosurgery, Clinical Hospital of Porto Alegre, Brazil.
  4. 4The Ohio State University College of Medicine, Columbus.
  5. 5Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus.
  6. 6Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Abstract

Background

Pituitary apoplexy is rare clinical entity resulting from hemorrhage or infarction of a pituitary tumor, typically presenting with headaches, endocrinopathy, and variable neurological manifestations. Recurrent apoplexy, particularly multiply recurrent cases, is exceedingly rare and associated with clinical equipoise in many cases.Observations

The authors report the case of an 85-year-old female who presented with three distinct episodes of pituitary apoplexy over 6 years, each presenting with acute headache in the absence of neurological deficits. Given the patient's age, lack of neurological symptoms, and personal preference, she did not undergo surgical intervention and was treated with only hormone replacement for hypopituitarism after the second episode.Lessons

This case highlights that nonsurgical management may be successful in carefully selected cases of pituitary apoplexy, although the risk of recurrence is an important consideration that is often overlooked in cases presenting with mild symptoms. The authors suggest that upfront surgery may be considered in younger patients, even in the setting of mild presentations that do not require emergency intervention, to avoid the potential morbidity of recurrent apoplexy. Better predictors of apoplexy recurrence will be helpful to develop increasingly personalized management strategies for these patients. https://thejns.org/doi/10.3171/CASE26461.

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Cite

BibTeXRIS
BibTeX
@article{landry2026multiply,
  title = {{Multiply recurrent pituitary apoplexy treated nonsurgically: illustrative case.}},
  author = {Alexander P Landry and Maíra Cristina Velho and Luma Ghalib and Daniel M Prevedello},
  journal = {Journal of neurosurgery. Case lessons},
  year = {2026},
  month = oct,
  doi = {10.3171/case26461},
  url = {https://europepmc.org/article/MED/42896228},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Multiply recurrent pituitary apoplexy treated nonsurgically: illustrative case.
AU  - Alexander P Landry
AU  - Maíra Cristina Velho
AU  - Luma Ghalib
AU  - Daniel M Prevedello
PY  - 2026
DA  - 2026/10/19
JO  - Journal of neurosurgery. Case lessons
DO  - 10.3171/case26461
UR  - https://europepmc.org/article/MED/42896228
AB  - Background  Pituitary apoplexy is rare clinical entity resulting from hemorrhage or infarction of a pituitary tumor, typically presenting with headaches, endocrinopathy, and variable neurological manifestations. Recurrent apoplexy, particularly multiply recurrent cases, is exceedingly rare and associated with clinical equipoise in many cases.Observations  The authors report the case of an 85-year-old female who presented with three distinct episodes of pituitary apoplexy over 6 years, each presenting with acute headache in the absence of neurological deficits. Given the patient's age, lack of neurological symptoms, and personal preference, she did not undergo surgical intervention and was treated with only hormone replacement for hypopituitarism after the second episode.Lessons  This case highlights that nonsurgical management may be successful in carefully selected cases of pituitary apoplexy, although the risk of recurrence is an important consideration that is often overlooked in cases presenting with mild symptoms. The authors suggest that upfront surgery may be considered in younger patients, even in the setting of mild presentations that do not require emergency intervention, to avoid the potential morbidity of recurrent apoplexy. Better predictors of apoplexy recurrence will be helpful to develop increasingly personalized management strategies for these patients. https://thejns.org/doi/10.3171/CASE26461.
SN  - 2694-1902
ER  -