The author presents a literature review searching the terms ‘pituitary ring sign’ and ‘sphenoid sinus mucosal thickening’ in the context of pituitary apoplexy from 1990 until the present day. These two findings are both magnetic resonance imaging (MRI) signs of pituitary apoplexy; this review explores the occurrence of both signs being present together in patients with ischaemic pituitary apoplexy. Twelve cases of ischaemic pituitary apoplexy were found with MRI images that showed both these signs. Ten of these cases were found in the literature and two additional cases evaluated by the author recently in a hospital setting. Of the 12 cases, both headache and visual loss were present in five patients, headache alone in five patients, with the remaining two patients having no initial symptoms reported. The author concludes that each sign (‘pituitary ring sign’ and ‘sphenoid sinus mucosal thickening’) alone may exist in patients with or without pituitary apoplexy, however, presence of both signs together in the appropriate clinical context is a strong predictor of pituitary apoplexy. The author reports this as an important finding as timely diagnosis and treatment of this condition can be vision and life-saving.