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Pituitary apoplexy precipitated by systemic chemotherapy (pre-contrast coronal T1-weighted MRI)

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A 31-year-old man with a recent diagnosis of seminomatous germ cell testicular cancer with metastases to the pelvis and retroperitoneum presented to the emergency department with several days of severe, progressive bifrontal headaches, nausea, and right-sided blurry vision 1 week after initiating chemotherapy (bleomycin, etoposide, and cisplatin). Neurologic examination was normal except for decreased right temporal visual acuity. MRI showed a 2.0×2.8×2.1 cm sellar and suprasellar mass with upward displacement of the optic chiasm (white arrow) and internal blood products. He underwent urgent transnasal transsphenoidal surgery. Pathological analysis showed a partially necrotic and hemorrhagic adenoma with rare growth hormone– and adrenocorticotropic hormone–positive tumor cells, with a low proliferation rate (Mib-1 less than 2%).. (Source: Hamrick FA, Findlay MC, Rennert RC, Budohoski KP, Couldwell WT. Pituitary apoplexy precipitated by systemic chemotherapy. Cureus 2022;14[3]:e23004. Creative Commons Attribution License [CC-BY 4.0].)