Pituitary Apoplexy

Abstract

Pituitary apoplexy is a clinical diagnosis corresponding to the acute onset of pituitary hemorrhage or infarction. It should be differentiated from pituitary hemorrhage, which may be an asymptomatic or incidental finding.

The clinical diagnosis is usually supported by imaging and pathological findings consistent with hemorrhage and/or infarction of a pituitary adenoma.

Most series report an incidence of less than 5 % in patients with pituitary tumors, although apoplexy has been reported in up to 21 % of patients with nonfunctioning macroadenomas.

The average age at clinical presentation is approximately 50 years.

It occurs more commonly in men.

Most patients (81 %) have no known history of a pituitary tumor.

Factors that may predispose patients to pituitary apoplexy include surgery, pregnancy, anticoagulation or coagulopathy, or radiosurgery.

At presentation with apoplexy, a sudden onset of headache may occur, which is frequently mistaken for subarachnoid hemorrhage.

Various common symptoms and signs at presentation have been reported:

• Headache (87–92 %)

• Hypopituitarism/fatigue (70–73 %)

• Diminished visual acuity (50–56 %)

• Cranial nerve paresis (45–54 %)

• Visual field deficits (34 %)

• Diminished level of consciousness (13–42 %)

• Diabetes insipidus (8 %)

• Hypopituitarism (especially hypocortisolemia) is the most life-threatening aspect of this condition. Panhypopituitarism occurs in up to 72 % of cases and should indicate immediate replacement therapy.