Multiply recurrent pituitary apoplexy treated nonsurgically: illustrative case.

BACKGROUND: 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.

OBSERVATIONS: 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's 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.

LESSONS: 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. https://thejns.org/doi/10.3171/CASE26461.