pituitary apoplexy

Etiology

• Hemorrhagic infarction of the pituitary
• risk factors
  • pituitary macroadenoma, including radiation-treated pituitary tumor
  • pregnancy (Sheehan's syndrome)
  • anticoagulation
  • diabetes mellitus
  • increased intracranial pressure
  • vasculitis: temporal arteritis

Clinical manifestations

• may be asymptomatic if hemorrhage is small or slow
  • onset generally acute
• acute & large hemorrhage
  • severe headache
    • nausea/vomiting
  • ophthalmoplegia
  • visual defects
    • bitemporal hemianopia
    • decreased visual acuity
    • extraocular muscle disorder
  • meningismus (stiff neck)
  • depressed sensorium
  • acute adrenocortical crisis
  • death may occur
• cranial nerve palsies may be noted
  • cranial nerve 3 palsy
  • cranial nerve 4 palsy
  • cranial nerve 6 palsy
• late sequelae
  • hypopituitarism
  • empty sella syndrome
  • regression of hypersecretory syndrome in an infarcted functioning pituitary tumor

Radiology

• CT of the head
• MRI of pituitary imaging test of choice

Complications

• leading cause of mortality is adrenal insufficiency secondary to ACTH deficiency

Management

• neurosurgical consultation
  • transsphenoidal neurosurgical decompression
    • oculomotor palsy
• stress dose glucocorticoids for pituitary-related adrenal insufficiency
  • give empirically prior to establishing diagnosis []
  • dexamethasone & mannitol for intracranial hypertension
• levothyroxine for hypothyroidism due to pituitary insufficiency
• +/- growth hormone for growth hormone deficiency

More general terms

• apoplexy
• pituitary disease

More specific terms

• Sheehan's syndrome

Additional terms

• empty sella syndrome
• meningism
• ophthalmoplegia (ophthalmoparesis)