Isolated primary amenorrhea in a 22-year-old female revealing pituitary apoplexy: a rare case report.

Introduction and importance: Pituitary apoplexy (PAP) is a rare, potentially life-threatening condition caused by hemorrhagic or ischemic infarction of a pituitary adenoma, classically presenting with sudden headache, visual disturbances, and altered consciousness. However, it can rarely present atypically, as in this case, with isolated primary amenorrhea as the sole manifestation, without the usual neuro-ophthalmic or acute symptoms, posing a significant diagnostic challenge. Case presentation: We report a case of a 22-year-old female presenting with primary amenorrhea with poorly developed secondary sexual characteristics, without classic symptoms of PAP. Hormonal profile suggested hypogonadotropic hypogonadism, and imaging revealed a pituitary lesion with high T2 signal and fluid-fluid level, consistent with apoplexy. Conservative management with hormonal replacement therapy led to the resumption of regular menstruation. Discussion: This case underscores the critical role of integrated hormonal evaluation and MRI in diagnosing an atypical presentation of PAP, uniquely manifesting as isolated primary amenorrhea without the usual neuro-ophthalmic or acute features. Conclusion: PAP should be considered as a potential diagnosis in young patients with unexplained primary amenorrhea, even in the absence of classic clinical signs. Early recognition and individualized treatment are crucial to optimize outcomes in the atypical presentation of PAP.