{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T18:54:51Z","timestamp":1792954491262,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,14]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>Pituitary apoplexy is a rare but life-threatening condition caused by acute ischaemia or haemorrhage within the pituitary gland, often occurring in pre-existing adenomas. We present a case of an unconscious patient with acute headache, initially managed empirically for suspected meningitis. Investigations, such as cerebrospinal fluid analysis, revealed initially xanthochromia, prompting evaluation for subarachnoid haemorrhage. Magnetic resonance imaging and pituitary function testing identified a pituitary macroadenoma with optic chiasm compression and hypopituitarism, leading to successful transsphenoidal resection.<\/jats:p>\n               <jats:p>This case underscores the importance of including pituitary apoplexy in the differential diagnosis of unconsciousness and severe headache, as it can mimic meningitis or subarachnoid haemorrhage (SAH). While SAH may precipitate apoplexy, xanthochromia can also arise independently from pituitary haemorrhage. Given the risk of rapid clinical deterioration from adrenal insufficiency, clinicians should consider pituitary apoplexy early in the evaluation to facilitate prompt management while also evaluating for other significant differential diagnoses.<\/jats:p>","DOI":"10.1136\/bcr-2024-263585","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T03:45:16Z","timestamp":1747971916000},"page":"e263585","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Pituitary apoplexy in the setting of severe headache and unconsciousness"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9563-9442","authenticated-orcid":false,"given":"Maahi","family":"Qureshi","sequence":"first","affiliation":[{"name":"Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0268-025X","authenticated-orcid":false,"given":"Karunakaran Pradeep","family":"Thozhuthumparambil","sequence":"additional","affiliation":[{"name":"Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"2025082712232799000_18.5.e263585.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2010.03913.x"},{"key":"2025082712232799000_18.5.e263585.2","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.3390\/jcm13092508","article-title":"Pituitary Apoplexy: An Updated Review","volume":"13","author":"Iglesias","year":"2024","journal-title":"J Clin Med"},{"key":"2025082712232799000_18.5.e263585.3","doi-asserted-by":"publisher","DOI":"10.1210\/er.2015-1042"},{"key":"2025082712232799000_18.5.e263585.4","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-005-1050-3"},{"key":"2025082712232799000_18.5.e263585.5","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23158721","article-title":"Pituitary Apoplexy: Risk Factors and Underlying Molecular Mechanisms","volume":"23","author":"Biagetti","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2025082712232799000_18.5.e263585.6","doi-asserted-by":"crossref","first-page":"72","DOI":"10.4103\/0028-3886.287669","article-title":"Pituitary Apoplexy: A Comprehensive Review","volume":"68","author":"Muthukumar","year":"2020","journal-title":"Neurol India"},{"key":"2025082712232799000_18.5.e263585.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03667.x"},{"key":"2025082712232799000_18.5.e263585.8","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0537"},{"key":"2025082712232799000_18.5.e263585.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0139088","article-title":"Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with Pituitary Adenoma","volume":"10","author":"Zhu","year":"2015","journal-title":"PLoS ONE"},{"key":"2025082712232799000_18.5.e263585.10","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000417"},{"key":"2025082712232799000_18.5.e263585.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.4.625"},{"key":"2025082712232799000_18.5.e263585.12","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.71.4.542"},{"key":"2025082712232799000_18.5.e263585.13","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1999.00754.x"},{"key":"2025082712232799000_18.5.e263585.14","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-0884"},{"key":"2025082712232799000_18.5.e263585.15","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198403000-00021"},{"key":"2025082712232799000_18.5.e263585.16","doi-asserted-by":"crossref","first-page":"206","DOI":"10.23907\/2016.023","article-title":"The Pituitary Gland: An Infrequent but Multifaceted Contributor to Death","volume":"6","author":"Wang","year":"2016","journal-title":"Acad Forensic Pathol"},{"key":"2025082712232799000_18.5.e263585.17","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1055\/s-0041-1733947","article-title":"Pituitary Apoplexy, Meningitis and Cerebral Infarction - 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