Pituitary Apoplexy in the Setting of ACTH-Secreting Adenoma: Systematic Review and Illustrative Case

Background: Cushing's disease is a commonly described although not commonly encountered pathology in which an excess of adrenocorticotropic hormone (ACTH) is produced by a functional pituitary adenoma, resulting in hypersecretion of cortisol by the adrenal glands.[1] [2] [3] Pituitary apoplexy is an even less common pathology that occurs due to acute hemorrhage or infarct of pituitary adenomas, more commonly in nonfunctional adenomas.[2] Very rarely do these uncommon pathologies occur simultaneously in the same patient. When managed surgically, apoplexy is typically a surgical emergency for decompression of the optic apparatus,[2] in contrast to ACTH-secreting adenoma, in which gross total resection is the goal of surgical intervention.[1] We present an updated systematic review on presentation and management of apoplexy in the setting of ACTH-secreting adenoma, with an unusual case illustrating presentation and management of these complex concomitant pathologies.