The timely diagnosis and optimal therapy of the pituitary apoplexy is challenging. We report a case about our treatment experience for the acute stage of pituitary apoplexy complicated with sinusitis. It is the strong predictor for the acute stage of pituitary apoplexy when magnetic resonance imaging(MRI) presented the both signs simultaneously, the pituitary ring sign and the sphnoid sinus mucosal thickening. Once the diagnosis of pituitary apoplexy is established, hypocortisolism and hyponatremia should be considered intensely. Surgical decompression via transsphnoid approach has favorable prognosis for the visual involvement of the pituitary apoplexy. Effective antibiotic for sphenoid sinusitis before surgery may could minimize the postoperative risk of intracranial infection. Otherwise, the sign of the sphenoid sinus mucosal thickening is not a contraindication for the transnasal transsphnoidal surgery.