The patient, a 44-year-old male, presented with sudden onset of headache, nausea, vomiting, and decreased vision without any obvious cause and entered the local hospital for treatment, and a cranial CT examination was performed, which revealed an occupying lesion in the saddle area. The patient’s condition deteriorated sharply that night, with a temperature of 41°C, delirium, impaired consciousness, a sharp decrease in visual acuity to faint light perception, hyponatremia (121 mmol/L) and total hypopituitarism. Magnetic resonance showed a pituitary stroke and upward hemorrhage into the suprasellar subarachnoid space and the three ventricles, making the patient’s condition complex and critical. The key issues in the treatment of fulminant and acute pituitary stroke are timely correction of pituitary crisis and the timing of surgery: different timing of surgery has different indications, advantages and disadvantages. Immediate surgery can relieve compression, improve visual acuity and pituitary function, and relieve cerebrospinal fluid circulation obstruction as soon as possible; while in critically ill patients, surgery should be postponed after correction of systemic status, which is safer. In this patient, we first corrected the electrolyte disorder, lowered the body temperature and corrected the pituitary crisis, and then performed minimally invasive surgery as soon as possible after the condition was stabilized and the systemic status improved. The patient recovered satisfactorily and resumed normal life and work 1 month after surgery. 3 months after surgery, the follow-up MRI showed that the patient’s tumor was completely resected, her vision was close to normal, and her hormone replacement therapy had reached normal level. Pituitary stroke is a clinical syndrome of headache, visual impairment, eye muscle paralysis and state of consciousness and acute hypopituitarism due to sudden bleeding or infarction of pituitary adenoma. Among them, patients with fulminant and acute pituitary strokes can rapidly develop severe neurological symptoms, coma and even death. Therefore, timely and correct diagnosis and treatment is the key to improving the outcome of patients with pituitary adenoma stroke. Fulminant and acute pituitary adenoma strokes are more dangerous. Patients with pituitary adenoma should be educated and should seek medical attention and pituitary-related tests when symptoms such as severe headache, blurred vision, eye muscle paralysis and altered state of consciousness occur to avoid delay in treatment.