Apoplexy of a pituitary macroadenoma with reversible third, fourth and sixth cranial nerve palsies following administration of hypothalamic releasinghormones: MR features

Pituitary apoplexy in patients with pituitary macroadenomas can occur eithe r spontaneously or following various interventions. We present a case of a 71-year-old woman who developed third, fourth, and sixth cranial nerve pals ies following administration of the four hypothalamic releasing hormones fo r routine preoperative testing of pituitary function. The MR examination sh owed interval tumor growth with impression of the floor of the third ventri cle. There were also changes in signal intensity characteristics of the mas s, suggestive of intratumoral bleeding. A transsphenoidal surgery with subt otal resection of the pituitary adenoma was performed. Microscopical examin ation revealed large areas of necrosis and blood surrounded by adenomatous tissue. Third, fourth, and sixth cranial nerve palsies completely resolved within 4 months. We conclude that MR imaging is useful in the demonstration of pituitary apoplexy following preoperative stimulation tests, but we sug gest that these tests should be abandoned in patients with pituitary macroa denomas. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.