Pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils

Acute clinical deterioration due to infarction or haemorrhage of an existin g, often previously unrecognized, pituitary tumour is a rare but well-descr ibed complication. It fan occur spontaneously or may be caused e.g. by mech anical ventilation, infection or surgical procedures. We report on a case o f pituitary apoplexy occurring in a 64-year-old patient 3 weeks after cardi ac surgery. The patient presented with deep coma and dilated pupils. Magnet ic resonance imaging revealed a haemorrhagic pituitary tumour. After prompt endocrinologic replacement therapy with levothyroxine and hydrocortisone t he patient regained consciousness. Neurological examination revealed right oculomotor nerve palsy and bilateral cranial nerve VI palsy. Subsequent tra ns-sphenoidal removal of a nonfunctional macroadenoma with large necrotic a reas was performed. The patient recovered completely. To our knowledge, pit uitary tumours presenting with a combination of deep coma and dilated pupil s must be considered exceedingly rare. Possible pathophysiologic mechanisms are discussed. As our case illustrates, even in severe cases complete reco very is possible if the diagnosis is suspected, and diagnostic and therapeu tic measures are initiated in time.