Abstract
AbstractHemorrhage or infarction of a pituitary tumor is termed pituitary apoplexy . Most patients experience abrupt onset of severe headache, altered mental status and visual changes. Visual loss may be unilateral or bilateral and the severity is variable. Ophthalmoplegia, usually due to compression of the ocular motor nerves in the cavernous sinus, may also be unilateral or bilateral. The 3rd nerve is most commonly affected. The clinical picture of acute 3rd nerve palsy associated with severe headache may be mistaken for aneurysmal subarachnoid hemorrhage Precipitating factors for pituitary apoplexy include hypotension, Valsalva maneuvers, malignant hypertension, pregnancy or exogenous estrogen administration and anticoagulation. Cranial MRI is the diagnostic test of choice. Morbidity and mortality are related to the abrupt onset of panhypopituitarism, particularly cortisol insufficiency. Acute management includes systemic corticosteroids in stress dosages (e.g., hydrocortisone 100 mg IV every 6‐8 hours), control of hemodynamic parameters (e.g.blood pressure) and correction of any metabolic derangements. Surgical decompression is usually performed as soon as the patient is stable.
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