Pituitary Apoplexy (PA) is a potentially fatal clinical condition resulting from ischaemic or haemorrhagic infarction of the pituitary gland. The ischaemic subtype is even rarer and more severe. We present the case of a 26-year-old female patient who presented with headache, acute bilateral visual loss, fever, confusion, asthenia with classic features of acromegaly, and pupils with bilateral areactive mydriasis without light perception bilaterally with cranial nerve involvement. Magnetic Resonance Imaging (MRI) confirmed the presence of a pituitary macroadenoma, and endocrine investigations revealed panhypopituitarism. The patient underwent transsphenoidal evacuation and the diagnosis of ischaemic PA was confirmed by histology. Three months later, a follow-up MRI showed an empty bowel with remission of acromegaly, diabetes and mild unilateral visual recovery. Our case highlights the importance of considering ischaemic PA among the possible aetiologies of sudden cranial nerve deficits then early diagnosis and treatment are essential to improve outcome.