Snapshot A 56-year-old man presents to the emergency department with a severe headache that occurred suddenly. The patient also complains of not seeing very well. Physical examination is notable for left-eye ptosis and a dilated pupil that is inferiorly and laterally deviated. A computerized tomography (CT) of the head is performed, which is shown to the right. Neurosurgery is immediately consulted. Overview Hemorrhage or infarction of the pituitary gland → pituitary gland volume increases login to view 1 more bullet Differential diagnosis login to view 2 more bullets Pathophysiology Pituitary adenomas are at risk of bleeding and undergoing necrosis login to view 4 more bullets Presentation Excruciating headache of acute onset Hypopituitarism Visual symptoms login to view 4 more bullets ± altered consciousness Diagnosis CT or MRI of the head login to view 5 more bullets Treatment/Management Debatable, but treatment is aimed at improving the patient's symptoms and relieving compression of surrounding structures (i.e., optic pathways) login to view 3 more bullets Neurosurgical emergency login to view 1 more bullet Corticosteroid therapy immediately login to view 2 more bullets Correction of electrolyte disturbances