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Endocrinopathies and Other Biochemical Abnormalities in Pituitary Apoplexy

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Pituitary Apoplexy

Abstract

Endocrinopathy and other biochemical abnormalities may be the result of the underlying macroadenoma or due to the pituitary apoplexy itself. Failure to recognise and treat any of these abnormalities may lead to increased morbidity and mortality in patients with pituitary apoplexy. The majority of patients will present with at least one anterior pituitary hormone deficiency, with ACTH the most common. Diabetes insipidus is seen in up to 27 % of cases and may be a presenting feature of pituitary apoplexy or only manifest postoperatively. Hyponatraemia is seen in up to 40 % of patients, may be an early or late event and may be related to surgery. SIADH is very uncommon.

The emergency management in an individual in whom pituitary apoplexy is suspected includes drawing blood for electrolyte and hormonal assessment. Careful attention to fluid management is necessary. Hydrocortisone replacement, even prior to getting the results of assays, is mandatory and helps in reducing haemodynamic instability.

There remains controversy around the timing of surgery and even if surgery is necessary in some cases. A reasonable approach is to perform early surgery, within the first week of symptoms, in patients with severely threatened vision, including blindness, or in whom there is a diminished level of consciousness. The advantage of delaying surgery in the rest of the patients is that it allows for a complete endocrine assessment and correction of fluid and electrolyte disturbances, permitting safer surgery and a better outcome.

The postoperative management revolves around careful monitoring of the patients electrolyte and fluid balance, remaining vigilant for the development of diabetes insipidus and treating it if necessary. The hydrocortisone dose is usually tapered to a maintenance dose, and at a later stage the cortisol requirement can be assessed. Thyroid hormone may also need to be replaced but only after 48 h of hydrocortisone.

Although the majority of patients will require anterior pituitary hormone replacement, there may be recovery of hormonal function in some patients. Permanent diabetes insipidus is present only in about 8 % of cases. All patients require an annual review of their endocrine status

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Abbreviations

ACTH:

Adrenocorticotrophic hormone

ADH:

Antidiuretic hormone

DI:

Diabetes insipidus

FSH:

Follicle-stimulating hormone

IGF-1:

Insulin-like growth factor-1

LH:

Luteinising hormone

SIADH:

Syndrome of inappropriate diuretic hormone

T4:

Thyroid hormone-4

UK:

United Kingdom

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Authors and Affiliations

  1. Division of Neurosurgery, Groote Schuur Hospital, University of Cape Town, OH 53 Old Main Building, Observatory, Cape Town, 7925, South Africa

    Patrick L. Semple MBChB, FCS(SA), MMed, PhD

  2. Division of Endocrinology, Groote Schuur Hospital, University of Cape Town, Observatory, Cape Town, 7925, South Africa

    Ian L. Ross MBChB, FCP(SA), Cert Endocrinol Metab, PhD

Authors
  1. Patrick L. Semple MBChB, FCS(SA), MMed, PhD
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  2. Ian L. Ross MBChB, FCP(SA), Cert Endocrinol Metab, PhD
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Correspondence to Patrick L. Semple MBChB, FCS(SA), MMed, PhD .

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Editors and Affiliations

  1. Department of Neurosurgery, Adnan Menderes University, School of Medicine, Aydin, Turkey

    Mehmet Turgut

  2. Department of Neurosurgery, All India Institute of Medical Sciences Neurosciences Center (AIIMS), New Delhi, India

    Ashok Kumar Mahapatra

  3. The Victor Horsley Nerosurgical Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom

    Michael Powell

  4. Department of Neurosurgery, Madurai Medical College, Madurai, Tamil Nadu, India

    Natarajan Muthukumar

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Semple, P.L., Ross, I.L. (2014). Endocrinopathies and Other Biochemical Abnormalities in Pituitary Apoplexy. In: Turgut, M., Mahapatra, A., Powell, M., Muthukumar, N. (eds) Pituitary Apoplexy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38508-7_13

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  • DOI: https://doi.org/10.1007/978-3-642-38508-7_13

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