Pituitary apoplexy is a rare and life-threatening complication that occurs in 0.6-10.5% of all patients with pituitary adenomas. Unfortunately, pituitary apoplexy is often misdiagnosed before surgery. Furthermore, in spite of all the advances in imaging techniques and therapeutic methods, its optimal management is still controversial owing to the limited individual experience and the very variable clinical course of the condition, which ranges from asymptomatic to critical illness with visual loss and subarachnoid hemorrhage. The management of visual dysfunction in particular remains a subject of debate.

Introduction: Definition, History, Frequency, Histopathology and Pathophysiology of Pituitary Apoplexy. Overview: Conservative versus Surgical Decompression for Pituitary Apoplexy. Tumours Types which Show Apoplexy: Predisposing factors for Pituitary Apoplexy.- Non-functioning tumour apoplexy.- Apoplexy in previously known tumours.- Post-operative Pituitary Apoplexy. Clinical Features: Clinical features of Pituitary Apoplexy.- Subarachnoid hemorrhage with Pituitary Adenoma.- Cerebral ischaemia in Pituitary Apoplexy. Visual and Endocrine Assessment: Visual acuity, eye movements and visual fields.- Visual outcome following Pituitary Apoplexy.- Preoperative endocrine function and fluid electrolyte balance.- Endocrinopathies and other biochemical abnormalities in Pituitary Apoplexy. Mimicking Conditions: Carotid artery aneurysm.- Hypothalamic lymphoma.- Rathke's cleft cysts mimicking Pituitary Apoplexy. Management: Conservative management of Pituitary Apoplexy.- Surgical decompression for Pituitary Apoplexy.- Timing of surgery and outcome in Pituitary Apoplexy. Complications: Subarachnoid hemorrhage after transsphenoidal surgery.