Pituitary apoplexy is a medical emergency that results from hemorrhage into or infarction of the pituitary gland, typically associated with a macroadenoma.   Symptoms and signs include the sudden onset of a severe headache (which can mimic subarachnoid hemorrhage), altered mental status, visual symptoms, and an acute hormonal withdrawal state. The visual symptoms result from compression of the optic chiasm or optic nerves resulting in visual field abnormalities or decreased visual acuity. The extraocular muscles may also be impaired due to compression of cranial nerves III, IV and VI that pass through the cavernous sinus, adjacent to the sella. Treatment consists of surgical decompression and urgent replacement of corticosteroids to prevent vascular collapse.