Trauma Unmasking Pituitary Apoplexy: Coexisting Epidural Hematoma and Sellar Mass - a Case Report With Selected Cases From the Literature Publisher



Safari Dehnavi N ; Ghaleh A ; Ranjbar M ; Riyahi Zaniyani F ; Khoshnevisan A ; Shafizadeh M
Source: International Medical Case Reports Journal Published:2026

Abstract

Background: Pituitary incidentalomas are sellar lesions identified on imaging performed for unrelated reasons. Lesions measuring 1 cm or larger are classified as macroincidentalomas. Pituitary apoplexy is an acute clinical syndrome caused by hemorrhage or infarction within the pituitary gland and may present with headache, ophthalmoplegia, altered consciousness, visual dysfunction, and hypopituitarism. Case Presentation: A 36-year-old man presented with decreased consciousness after a motor vehicle crash. Noncontrast CT revealed a right parietal epidural hematoma with approximately 5 mm of midline shift and an incidental sellar mass. Emergency craniotomy and hematoma evacuation were performed, after which his Glasgow Coma Scale score improved to 15. Family members reported that left eyelid ptosis had begun 10 days before the crash. Subsequent MRI demonstrated a large heterogeneous sellar-suprasellar mass with T1-hyperintense components compatible with pituitary apoplexy. Endocrine evaluation showed central hypothyroidism, reduced gonadotropins, low prolactin, normal morning cortisol, and low-normal ACTH. Following endocrinology consultation, perioperative hydrocortisone was administered and later tapered. Endoscopic transsphenoidal resection revealed chronic motor oil-like blood and fragmented dark clot within the tumor. Histopathology confirmed a gonadotroph pituitary neuroendocrine tumor with a Ki-67 labeling index below 1%. The left ptosis resolved completely by the 3-month follow-up. Conclusion: Life-threatening traumatic lesions may coexist with sellar emergencies and obscure their neurological and endocrine manifestations. In this case, pre-injury left ptosis suggested that the sellar process preceded the crash, whereas the role of trauma as a precipitating or aggravating factor could not be established. After stabilization of the traumatic lesion, targeted sellar imaging and early endocrine involvement should be considered when cranial nerve findings or endocrine abnormalities remain unexplained. © 2026 Safari Dehnavi et al.