An unusual case of sudden onset headache due to pituitary apoplexy: a case report and review of the new UK guidelines

Spontaneous pituitary apoplexy in the absence of a known pre-existing pituitary adenoma is a very rare cause of sudden onset headache, but can be potentially sight- and life-threatening. We describe a case of a 37-year-old man who presented to the Emergency Department with a severe headache, associated nausea, vomiting and features of meningism. A suspected clinical diagnosis of subarachnoid haemorrhage led to an urgent computed tomography scan of the head demonstrating a large pituitary macroadenoma. A diagnosis of pituitary apoplexy was suspected and he was transferred as an emergency case to the regional tertiary hospital for management. A further urgent magnetic resonance imaging scan showed haemorrhage into the pituitary adenoma, confirming pituitary apoplexy. We discuss this clinical condition and the new UK national guidelines which have recently been published to improve clinical assessment, investigation and management of patients with suspected pituitary apoplexy.