Pituitary apoplexy – Quick review chart

Pituitary apoplexy Damage to the pituitary gland 
due to reduced blood flow , Infarction or haemorrhage- causes ” sudden death ” of the gland.

tumor expands due to haemorrhage 
( main reason for symptoms ) pressure on the optic nerve or chiasm causes visual manifestations sudden interruption in release of hormone causes hormonal dysfunction

Higher risk pre-existing pituitary adenoma patients are usually unaware of the condition about 5 % with pre-existing adenoma may develop apoplexy bigger the tumor ( macroadenoma ) greater the risk precipitants can be endocrine stimulation tests , bromocriptine or cabergoline treatment , gonadotrophin releasing hormone treatment ,lumbar fusion in prone position ,pregnancy , pituitary irradiation , anticoagulation , thrombocytopenia , erectile dysfunction medications , ↑ or ↓ BP , surgery , infections.

Classic triad
 headache vomiting visual impairment , sudden onset headache located behind the eye change in eye-sight as double vision , restriction of eye movement , hemianopia , ptosis diplopia – extrinsic compression of one or several extraocular nerve drowsiness lack of ACTH -adrenal crisis

Sheehan syndrome -in post-partum women necrosis of the gland following sig bleeding during childbirth presentation is with adrenal insufficiency , hypothyroidism , hypopituitarism

Imaging ( CT , MRI ) Blood tests Lumbar puncture , infectious meningitis cavernous sinus thrombosis migraine stroke hyperemesis gravidarum

neurosurgical emergency urgent treatment /monitoring is required best management -not well defined selected patients – conservative approach 
( wait and see ) trans-sphenoidal surgery to relieve pressure hormone replacement ( if the gland fails to resume normal function )

REFERENCES

1. Pituitary disease fact file The Pituitary Foundation Information Booklets https://www.pituitary.org.uk/media/311036/GP-fact-file_A5_16-10-15.pdf
2. Mayol Del Valle M, De Jesus O. Pituitary Apoplexy. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559222/
3. Hannoush ZC, Weiss RE. Pituitary Apoplexy. [Updated 2018 Apr 22]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279125/
4. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary Apoplexy. Endocr Rev. 2015 Dec;36(6):622-45. doi: 10.1210/er.2015-1042. Epub 2015 Sep 28. PMID: 26414232 (Abstract ). https://pubmed.ncbi.nlm.nih.gov/26414232/