Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage. Craniopharyngioma may be difficult to distinguish from pituitary apoplexy. In this study, we discuss a case of pituitary apoplexy in a 19-year-old male patient lit our patient, the tumor was confused with a craniopharyngioma because of the suprasellar extension of the tumor on magnetic resonance (MR) images and the hyperintensity in T1-weighted images, the voting age of the patient, and the gradually progressive onset of the symptoms In conclusion, even without a known history of pituitary adenoma or an abrupt onset of the clinical symptoms, the diagnosis of pituitary apoplexy should be considered in a patient with a suprasellar mass hyperintensity in T1-weighted MR images. which may mimic craniopharyngioma (C) 2008 Elsevier Masson SAS. All rights reserved.