Pituitary Apoplexy Manifested as Subarachnoid Hemorrhage Accompanied by Primary Hypothyroidism A Case Report

A 37-year-old woman presented with sudden onset of severe headache and vomiting. Cerebrospinal fluid examination was consistent with subarachnoid hemorrhage, but no venous sinus thrombosis or aneurysmal bleeding was found by magnetic resonance angiography or computed tomography angiography. Pituitary magnetic resonance imaging revealed a suprasellar mass with intratumoral hemorrhage. The patient's history revealed symptoms of hypothyroidism over the past 10 years. Primary hypothyroidism was confirmed by markedly decreased free T4 and T3 along with elevated thyroid-stimulating hormone levels. The patient was treated conservatively with mannitol to reduce intracerebral pressure, followed by hydrocortisone and levothyroxine. After 3 months of levothyroxine replacement, an magnetic resonance imaging revealed slight shrinkage of the pituitary gland.