Pituitary apoplexy is a rare, potentially life-threatening complication which has been described after both on and off-pump CABG. However, never before has pituitary adenoma recurrence after prior resection and subsequent apoplexy leading to severe ophthalmoplegia following on-pump CABG been described. We present the case of a patient who previously underwent transsphenoidal resection of a pituitary adenoma who experienced oculomotor nerve palsy following on-pump CABG and was ultimately found to have a recurrent pituitary adenoma and apoplexy.