{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:38:37Z","timestamp":1792543117840,"version":"4.5.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"\n BACKGROUND<\/jats:title>\n Pituitary apoplexy is rare clinical entity resulting from hemorrhage or infarction of a pituitary tumor, typically presenting with headaches, endocrinopathy, and variable neurological manifestations. Recurrent apoplexy, particularly multiply recurrent cases, is exceedingly rare and associated with clinical equipoise in many cases.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of an 85-year-old female who presented with three distinct episodes of pituitary apoplexy over 6 years, each presenting with acute headache in the absence of neurological deficits. Given the patient\u2019s age, lack of neurological symptoms, and personal preference, she did not undergo surgical intervention and was treated with only hormone replacement for hypopituitarism after the second episode.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights that nonsurgical management may be successful in carefully selected cases of pituitary apoplexy, although the risk of recurrence is an important consideration that is often overlooked in cases presenting with mild symptoms. The authors suggest that upfront surgery may be considered in younger patients, even in the setting of mild presentations that do not require emergency intervention, to avoid the potential morbidity of recurrent apoplexy. Better predictors of apoplexy recurrence will be helpful to develop increasingly personalized management strategies for these patients.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26461<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26461","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:01:01Z","timestamp":1791936061000},"source":"Crossref","is-referenced-by-count":0,"title":["Multiply recurrent pituitary apoplexy treated nonsurgically: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Alexander P.","family":"Landry","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario;"},{"name":"Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-4566","authenticated-orcid":true,"given":"Ma\u00edra Cristina","family":"Velho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Hospital of Porto Alegre, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0077-0665","authenticated-orcid":true,"given":"Luma","family":"Ghalib","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus;"},{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0214-2339","authenticated-orcid":true,"given":"Daniel M.","family":"Prevedello","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus;"},{"name":"Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"52","article-title":"Presenting symptoms of pituitary apoplexy","volume":"79","author":"Pyrgelis","year":"2018","unstructured":"Pyrgelis ESMavridis IMeliou M.Presenting symptoms of pituitary apoplexy. J Neurol Surg A Cent Eur Neurosurg. 2018;79(1):52-59. doi:10.1055\/s-0037-1599051"},{"issue":"4","key":"bib2","series-title":"Neurosurg Clin N Am","first-page":"457","article-title":"Pituitary apoplexy","volume":"30","author":"Barkhoudarian","year":"2019","unstructured":"Barkhoudarian GKelly DF.Pituitary apoplexy. Neurosurg Clin N Am. 2019;30(4):457-463. doi:10.1016\/j.nec.2019.06.001"},{"issue":"4","key":"bib3","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"408","article-title":"Isolated sixth cranial nerve palsy in patients with pituitary apoplexy","volume":"86","author":"Atallah","year":"2025","unstructured":"Atallah OBadary ASanker VIsolated sixth cranial nerve palsy in patients with pituitary apoplexy. 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