Chapter 48 - Pituitary apoplexy

Abstract

Pituitary apoplexy (PA) is the sudden hemorrhagic or ischemic infarction of a preexisting pituitary adenoma, characterized by sudden severe headache, visual disturbances, diplopia, nausea, vomiting, and/or deterioration of consciousness. These symptoms are caused by the sudden enlargement of the hemorrhagic pituitary mass, compressing the pituitary gland and neighboring anatomical structures. The major endocrine complication of PA is secondary adrenal insufficiency, which must not be overlooked and treated timely. The pathophysiology of PA is only partly understood. Risk factors include major surgery, dynamic endocrine testing, anticoagulant medication, and other conditions, all of which presumably cause a change of hemodynamic parameters in the pituitary adenoma. Diagnosis is usually made based on clinical symptoms and magnetic resonance imaging. PA can be treated by transsphenoidal pituitary surgery or be managed conservatively, subject to the individual case and severity of neuroophthalmological symptoms. After the acute event, patients must be counseled to adhere to long-term follow-up.