Abstract
Insult to the pituitary can be in the form of hemorrhage, infarction or both. When abrupt and sometimes catastrophic hemorrhagic infarction occurs in the pituitary it is defined as apoplexy. The constellation of headache, vomiting, visual impairment (Apoplexy Triad) and altered consciousness with hemodynamic instability, although not specific for pituitary apoplexy, are reasons to consider the diagnosis (Table 1). Often the presentation in this dramatic fashion is the first time the patient is aware that he/she harbors a pituitary tumor. Asymptomatic hemorrhage and infarct into a pituitary tumor can occur in 10-25% of patients, however true apoplexy (the constellation of symptoms noted above) occurs in 2-10% of pituitary tumor patients.