Pituitary apoplexy


Pituitary apoplexy

Description, Causes and Risk Factors:

The word apoplexy is defined as a sudden neurologic impairment, usually due to a vascular process. Pituitary apoplexy is characterized by a sudden onset of headache, visual symptoms, altered mental status, and hormonal dysfunction due to acute hemorrhage or infarction of a pituitary gland. An existing pituitary adenoma is usually present. The visual symptoms may include both visual acuity impairment and visual field impairment from involvement of the optic nerve or chiasm and ocular motility dysfunction from involvement of the cranial nerves traversing the cavernous sinus. It is important to note that pituitary apoplexy may be divided into hemorrhagic or ischemic, each with unique neuroimaging findings.

Some postulate that a gradual enlarging pituitary tumor becomes impacted at the diaphragmatic notch, compressing and distorting the hypophyseal stalk and its vascular supply. This deprives the anterior pituitary gland and the tumor itself of its vascular supply, apoplectically causing ischemia and subsequent necrosis.

Another theory stipulates that rapid expansion of the tumor outstrips its vascular supply, resulting in ischemia and necrosis. This explanation is doubtful, since most tumors that undergo apoplexy are slow growing.

This condition results in an estimated 1.5-27.7% of cases of pituitary adenoma, although the figure is probably closer to 10%.

Symptoms:

Symptoms may include:

    Headache.

  • Visual field or acuity reduction.

  • Ocular palsies.

  • Nausea and vomiting.

  • Meningis.

  • Decreased level of consciousness.

  • Photophobia.

  • Fever.

Diagnosis:

Your doctor will conduct a thorough physical exam and ask you about your symptoms and medical history. Other diagnostic procedures include:

    Magnetic resonance imaging (MRI).

  • Hormone testing.

  • Visual testing.

One method doctors use to diagnose pituitary apoplexy is using MRI scans. You may also undergo a computerized tomography (CT) scan of the pituitary gland, which will also show if there is an abnormality.If your symptoms suggest pituitary failure (hypopituitarism), you need a complete evaluation of the endocrine system.Based on results of these blood tests, your doctor may order additional hormonal studies.

If you suffer from visual symptoms, then an experienced ophthalmologist should evaluate you. This evaluation should include:

    Acuity testing of each eye.

  • Formal visual field testing to determine if there is loss of peripheral vision.

Treatment:

Treatment options for pituitary apoplexy include:

    Rapid administration of high-dose corticosteroid.

  • Careful monitoring of fluid and electrolyte levels.

  • Urgent transsphenoidal surgery.

If the pituitary adenomas require surgery, typically the best procedure is through a nasal approach. Neurosurgeons who specialize in pituitary tumor surgery are experts in the minimally invasive endoscopic endonasal technique. This procedure removes the tumor while minimizing complications, hospital time and discomfort. This advanced technique requires specialized training and equipment.

No matter what course of treatment you undergo, one of our experienced endocrinologists will monitor you carefully during treatment and recovery.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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