From the Guidelines
Pituitary apoplexy is a sudden onset of neurological symptoms and hormonal dysfunction related to either hemorrhagic or vascular impairment of the pituitary gland.
Key Characteristics
- It can occur as the initial manifestation of an adenoma or in the clinical setting of treated adenoma, prior radiation treatment, pregnancy, anticoagulation, and trauma 1
- Symptoms may include sudden headache, oculomotor palsies, and hormonal dysfunction 1
- Imaging, particularly MRI, is often used to detect pituitary hemorrhage and diagnose pituitary apoplexy 1
Diagnosis and Management
- MRI is considered the optimal first-line test for diagnosing pituitary apoplexy, as it can detect acute pituitary hemorrhage and tumor enlargement 1
- CT may be considered as part of the initial diagnostic evaluation to exclude intracranial hemorrhage or mass lesion, particularly in emergency settings 1
- Management may involve surgery, and in some cases, early surgery may be beneficial, especially in severe cases or those with significant mass effect 1
Clinical Presentation
- Pituitary apoplexy can present with mass effects on surrounding structures, including headache, visual field defects, and hypopituitarism 1
- It is likely more common in children and adolescents with non-functioning pituitary adenomas (NFPAs) than in adults 1
From the Research
Definition and Characteristics of Pituitary Apoplexy
- Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland 2, 3, 4, 5, 6.
- It is characterized by the sudden onset of headache, and may also be accompanied by nausea, vomiting, visual disturbances, and decreased level of consciousness 2, 3, 4, 5, 6.
Clinical Presentation
- The clinical presentation of PA can vary widely, but common symptoms include headache, visual disturbances, extraocular palsies, and altered sensorium 2, 3, 4, 5, 6.
- Hormonal and/or electrolyte disturbances are also common at the time of presentation, and need to be quickly corrected 2, 3, 4, 5.
Diagnosis and Treatment
- The diagnostic approach to PA includes both neuroimaging and evaluation of pituitary secretory function 3.
- Treatment options for PA include conservative management with periodic follow-up or neurosurgical intervention, and should be individualized based on the severity of the clinical picture 2, 3, 4, 5.
- Surgery is generally performed through the trans-sphenoidal route, and most patients have a good recovery in visual function and extraocular palsy 4, 5.
Epidemiology and Risk Factors
- PA can occur at any age, but is more common in men aged 50-60, and is rare in children and adolescents 2.
- Precipitating factors are present in up to 30% of cases, and include systemic, iatrogenic, and external factors, as well as the presence of an underlying pituitary tumor 2, 3, 5.
- The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET) 2.