Pituitary apoplexy

Pituitary apoplexy is a life-threatening medical condition in which there is sudden haemorrhage and/or infarction of the pituitary gland.

It is characterized by
  • Sudden onset of headache – usually retro-orbital 
  • Vomiting 
  • Visual impairment – bitemporal hemianopia
  • Decreased consciousness 

The most common cranial nerve palsy associated with pituitary apoplexy is the third
The fourth and sixth nerves are also vunerable.

Pituitary apoplexy usually occurs in patients with pre-existing pituitary adenomas. 

Precipitating factors include: 
  • Hypertension 
  • Major surgery, especially CABG 
  • Dynamic pituitary function tests with GnRH, TRH and CRH 
  • Pregnancy
  • Head trauma
  • Anticoagulation therapy

  • Bloods – U&Es, LFTs, FBC, clotting, random cortisol, prolactin, free T4, TSH, IGF-1, GH, LH and FSH 
  • MRI 

  • IV hydrocortisone 100-200mg (acute secondary adrenal insufficiency occurs in 2/3rds of patients) 
  • Urgent endocrinological and neurosurgical input

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