Please register or login to view the chart

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/

Share

Related Charts:

Add Your Comments

Your email address will not be published.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

A4 Medicine  - Search Less and Learn More

Welcome to the A4 medicine community where we are constantly working to provide exceptional educational material to primary health care professionals. Subscribe to our website for complete access to our A4 Charts. They are aesthetically designed charts that contain 300 (plus and adding) common and complex medical conditions with the all information required for primary care in one single page that can help you in consultation/practice and exam.

Additionally, you will get complete access for our Learn From Experts : A4 Webinar Series in which domain experts share the video explainer presentation on one medical condition in one hour for the primary care. And you will also get a hefty discount on our publications and upcoming digital products.

We are giving a lifetime flat 30% discount to our first thousand users, discount code already applied to checkout.