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Pituitary macroadenoma presenting with pituitary apoplexy in Sanglah Hospital, Bali-Indonesia


Introduction:  Pituitary apoplexy (PA) is a rare clinical syndrome in adolescents that can cause a life-threatening situation. This review describes the main clinical and MRI findings in two patients with pituitary macroadenoma presenting with pituitary apoplexy in Sanglah Hospital.

Case Report: A 61-year-old male patient was admitted to the Sanglah Hospital because of a sudden intense headache, accompanied by nausea and vomiting, and a history of blurred vision. Physical examination showed papil atrophy in his left and right eyes. His laboratory finding was unremarkable.  The second case is a 57-year-old female patient, was admitted because of sudden-onset severe headache, with vomiting and fever as well. Laboratory testing showed an elevated prolactin level.

Discussion: Haemorrhage and necrosis within a pituitary tumor are frequently incidentally observed by Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). They are often asymptomatic, configuring the subclinical pituitary apoplexy, and occur in 14 –22% of patients with a pituitary macroadenoma. MRI predominantly showed an intra- and suprasellar expanding mass with different signal intensities on T1WI and T2WI, depending on the presence of hemorrhage and on its stage. In first patient the MRI findings are extra-axial mass from intra to supra sella which attached to cavernous sinus and caused compression of chiasma opticum to superior. The second patient showed a pituitary tumor without supra-sellar expansion. In these two patient, the masses showed isointense and hyperintense signal intensity in T1W1, T2W1, FLAIR indicating the presence of intratumoral hemorrhage, and after Gad revealed inhomogen contrast enhancement.

Conclusion: Two patient in Sanglah Hospital showed acute clinical syndrome appearance of apoplexy, simultaneously with the presence of pituitary macroadenoma hemorrhage in MRI findings. The situation must be reported immediately because early diagnostic and prompt treatment it’s very important for a better prognosis.


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How to Cite

Wijayaningrum, S. E., Asih, M. W., & Martadiani, E. D. (2019). Pituitary macroadenoma presenting with pituitary apoplexy in Sanglah Hospital, Bali-Indonesia. Medicina, 50(2).




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Sherly Eva Wijayaningrum
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Medicina Journal

Made Widhi Asih
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Medicina Journal

Elysanti Dwi Martadiani
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Medicina Journal