What is pituitary apoplexy?
Pituitary apoplexy is sudden hemorrhage into the pituitary gland. Patients usually present with a severe headache and visual changes.
Pituitary apoplexy is the abrupt destruction of the majority of the anterior pituitary cells, resulting from an infarction of and/or acute hemorrhage into the pituitary gland or a pituitary adenoma.
Not infrequently, pituitary apoplexy is the first manifestation of a pituitary macroadenoma.
Precipitating factors include anticoagulation therapy, bleeding disorders, head trauma, diabetes mellitus, and radiation therapy. Patients usually present with severe headaches, obtundation, ophthalmoplegia, visual loss, hypotension, and shock.
Acute hemorrhage into a pituitary adenoma on pituitary MRI scanning and demonstration of biochemical hypopituitarism confirm the diagnosis. Rapid glucocorticoid and thyroid replacement therapies and surgical decompression, if needed, are life-saving measures.
Of note, small hemorrhages within pituitary adenomas may be incidentally detected during annual MRI surveillance of these tumors.
Neurosurgery should be consulted as surgical decompression of the pituitary may be necessary.
Additionally, stress doses of hydrocortisone should be given intravenously emergently because of the risk of adrenal failure (disruption in adrenocorticotropic hormone production) and subsequent shock.
Pituitary apoplexy is a syndrome commonly associated with a pituitary tumor that develops following an acute hemorrhage into or infarction of the tumor.
Patients may present with sudden onset of severe headache accompanied by visual loss, ophthalmoplegia, facial numbness, altered mental status, cardiovascular collapse, and hormonal dysfunction.
Treatment involves medical management with corticosteroid replacement for any pituitary insufficiency and evaluation of electrolytes with appropriate treatment.
Surgical decompression of the tumor may also be indicated if there are symptoms of mass effect from the tumor, such as vision loss or ophthalmoplegia.
