<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932025000100411</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2025.e12142511</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Apoplejía hipofisaria: manifestación súbita de un macroadenoma silente]]></article-title>
<article-title xml:lang="en"><![CDATA[Pituitary apoplexy: sudden manifestation of a silent macroadenoma]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Valdez Martínez]]></surname>
<given-names><![CDATA[Valeria Rosalba]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Acosta Colmán]]></surname>
<given-names><![CDATA[Karina Raquel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Católica Nuestra Señora de la Asunción Facultad de Ciencias de la Salud Hospital Central de IPS]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2025</year>
</pub-date>
<volume>12</volume>
<numero>1</numero>
<fpage>411</fpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932025000100411&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932025000100411&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932025000100411&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La apoplejía hipofisaria constituye una urgencia neuroendócrina poco frecuente, habitualmente provocada por hemorragia o isquemia en un adenoma hipofisario previamente existente. En este reporte se presenta el caso de un paciente masculino de 69 años que, tras ser diagnosticado con un macroadenoma hipofisario silente y sin síntomas al inicio, presentó de forma súbita una apoplejía hipofisaria. El cuadro clínico incluyó cefalea intensa, alteración visual y déficit hormonal. A pesar de la ausencia de manifestaciones clínicas relevantes antes del evento, el diagnóstico se confirmó mediante estudios de neuroimagen y evaluación hormonal. El abordaje terapéutico, que consistió en intervención quirúrgica, permitió una recuperación parcial de la función visual y hormonal. Este caso destaca la importancia de la vigilancia de pacientes con macroadenomas hipofisarios, incluso cuando están clínicamente silentes, ya que pueden presentar complicaciones agudas y graves como la apoplejía hipofisaria.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Pituitary apoplexy is a rare neuroendocrine emergency, usually caused by hemorrhage or ischemia in a previously existing pituitary adenoma. This report presents the case of a 69-year-old male patient who, after being diagnosed with a silent pituitary macroadenoma without symptoms at onset, suddenly presented with a pituitary apoplexy. The clinical picture included severe headache, visual disturbance, and hormonal deficit. Despite the absence of relevant clinical manifestations before the event, the diagnosis was confirmed by neuroimaging studies and hormonal evaluation. The therapeutic approach, which included surgical intervention, enabled partial recovery of visual and hormonal function. This case highlights the importance of surveillance of patients with pituitary macroadenomas, even when they are clinically silent, as they can present acute and severe complications such as pituitary apoplexy.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[apoplejía hipofisaria]]></kwd>
<kwd lng="es"><![CDATA[neoplasias hipofisarias]]></kwd>
<kwd lng="es"><![CDATA[cefalea]]></kwd>
<kwd lng="es"><![CDATA[hipopituitarismo]]></kwd>
<kwd lng="en"><![CDATA[pituitary apoplexy]]></kwd>
<kwd lng="en"><![CDATA[pituitary neoplasms]]></kwd>
<kwd lng="en"><![CDATA[headache]]></kwd>
<kwd lng="en"><![CDATA[hypopituitarism]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zou]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Yang]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Gao]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ou]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Luo]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
<name>
<surname><![CDATA[Yang]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Cheng]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term pituitary function following transsphenoidal surgery for non-functional pituitary neuroendocrine tumor with apoplexy: a single-center retrospective analysis]]></article-title>
<source><![CDATA[Sci Rep]]></source>
<year>2025</year>
<volume>15</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>19226</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Briet]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Salenave]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Chanson]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pituitary apoplexy]]></article-title>
<source><![CDATA[Endocrinol Metab Clin North Am]]></source>
<year>2015</year>
<volume>44</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>199-209</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wildemberg]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Glezer]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bronstein]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
<name>
<surname><![CDATA[Gadelha]]></surname>
<given-names><![CDATA[MR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Apoplexy in nonfunctioning pituitary adenomas]]></article-title>
<source><![CDATA[Pituitary]]></source>
<year>2018</year>
<volume>21</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>138-44</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pyrgelis]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
<name>
<surname><![CDATA[Mavridis]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Meliou]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Presenting symptoms of pituitary apoplexy]]></article-title>
<source><![CDATA[J Neurol Surg A Cent Eur Neurosurg]]></source>
<year>2018</year>
<volume>79</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>52-9</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arbunea-Ghenoiu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Ciubotaru]]></surname>
<given-names><![CDATA[GV]]></given-names>
</name>
<name>
<surname><![CDATA[Dumitra&#351;cu]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Alexandrescu]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Capatina]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Poiana]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pituitary apoplexy]]></article-title>
<source><![CDATA[Cureus]]></source>
<year>2022</year>
<volume>14</volume>
<numero>9</numero>
<issue>9</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Iglesias]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pituitary apoplexy]]></article-title>
<source><![CDATA[J Clin Med]]></source>
<year>2024</year>
<volume>13</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>2508</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garcia-Feijoo]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Perez Lopez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Paredes]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Cancela]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Alvarez-Escola]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Calatayud]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Exploring risk factors of severe pituitary apoplexy]]></article-title>
<source><![CDATA[Endocrine]]></source>
<year>2024</year>
<volume>86</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>333-41</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Giritharan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gnanalingham]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Kearney]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pituitary apoplexy-bespoke patient management allows good clinical outcome]]></article-title>
<source><![CDATA[Clin Endocrinol]]></source>
<year>2016</year>
<volume>85</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>415-22</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Serramito García]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Santín Amo]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Román Pena]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Pita Buezas]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[González Gómez]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[García Allut]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infarto cerebral tras apoplejía pituitaria]]></article-title>
<source><![CDATA[Neurocirugía]]></source>
<year>2016</year>
<volume>27</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>310-4</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pineda-Centeno]]></surname>
<given-names><![CDATA[LM]]></given-names>
</name>
<name>
<surname><![CDATA[Palacios-Rodríguez]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
<name>
<surname><![CDATA[Moncada-Habib]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Mondragon-Soto]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Hernández]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Pituitary apoplexy]]></article-title>
<source><![CDATA[Cureus]]></source>
<year>2024</year>
<volume>16</volume>
<numero>6</numero>
<issue>6</issue>
</nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lammert]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Walter]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Giordano]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Al Zhgloul]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Krämer]]></surname>
<given-names><![CDATA[BK]]></given-names>
</name>
<name>
<surname><![CDATA[Nittka]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Neuro-endocrine recovery after pituitary apoplexy]]></article-title>
<source><![CDATA[Exp Clin Endocrinol Diabetes]]></source>
<year>2020</year>
<volume>128</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>283-9</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Capatina]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Inder]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Karavitaki]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Wass]]></surname>
<given-names><![CDATA[JAH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of endocrine disease]]></article-title>
<source><![CDATA[Eur J Endocrinol]]></source>
<year>2015</year>
<volume>172</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>R179-90</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
