Pituitary Apoplexy
Clinical Setting:
➧ Hemorrhagic infarction of a pituitary adenoma/tumor.
➧ Sudden crisis in a patient with a known or previously unknown pituitary tumor.
➧ It may occur in a normal gland during and after childbirth, with head trauma, or in a patient on anticoagulation therapy.
➧ Sheehan’s Syndrome:
-Refers to pituitary apoplexy of the non-tumorous gland. It is due to the postpartum arterial spasm of arterioles supplying the anterior pituitary and its stalk.
Clinical Picture:
➧ Severe headache and visual disturbance
➧ Bitemporal hemianopia (Figure 1)
➧ CN III palsy
➧ Meningeal symptoms with neck stiffness
➧ Symptoms of secondary acute adrenal insufficiency:
-Nausea, vomiting, hypotension, and collapse
 |
| Figure 1: Bitemporal Hemianopia |
Diagnosis:
➧ CT/MRI scan of head and pituitary
➧ Hormonal studies only of academic interest
➧ Assessment of pituitary function after the acute stage has settled
Management:
a) Hormonal:
➧ Dexamethasone: 4 mg/12 h.
-Glucocorticoid support and relief of cerebral edema.
b) Neurosurgical:
➧ Transsphenoidal pituitary decompression
-After the acute episode the patient must be evaluated for multiple pituitary deficiencies.
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