Pituitary Apoplexy

Pituitary apoplexy occurs when a pituitary tumor spontaneously hemorrhages or when it outgrows its blood supply. Pituitary adenomas can suddenly bleed internally, leading to an abrupt increase in size which can cause compression of the pituitary gland and perisellar structures, the optic nerves, and the nerves that control eye movements. Pituitary tumor apoplexy is a rare endocrine emergency and is a potentially life-threatening disorder. All types of pituritary adenomas can be associated with apoplexy, especially larger tumors (macroadenomas). Signs and symptoms of pituitary apoplexy include headache, visual impairment, nausea and vomiting, altered mental status, meningismus, and fever. Headaches are the most prominent symptom in patients with pituitary apoplexy.

Pituitary apoplexy is best diagnosed with an MRI scan of the brain, with special attention to the pituitary. A CT scan of the pituitary gland also shows and abnormality but MRI is the preferred exam.

Effective treatment of pituitary apoplexy requires prompt administration of high-dose corticosteroid along with careful monitoring of fluid and electrolyte levels, and in most cases urgent transsphenoidal surgery is required. Careful monitoring of hormonal status by an endocrinologist during the acute phase of apoplexy and in the recovery phase is essential. Most patients have significant visual improvement after surgery, however allot of patients will have permanent hormone deficiencies due to pituitary injury and will require hormone replacement therapy for life. Thanks to the steroid medications we have today, patients rarely die from pituitary apoplexy if promptly diagnosed and treated.