Pituitary Apoplexy

Spina Bifida

Pituitary apoplexy or pituitary tumor apoplexy is a rare and potentially fatal condition in which a pituitary tumor (usually one larger than 10 mm) spontaneously hemorrhages or bleeds. This is an acute condition that requires urgent medical diagnosis and treatment. The term also refers to a rare condition where the pituitary tumor outgrows its blood supply resulting in a stroke or infarction (death of an area of tissue).

The pituitary is a small gland that can be found at the base of the brain and its main function is secretion of various hormones for normal functioning of the body. When pituitary apoplexy occurs, in about 80% of the cases, the patient is unaware of having a pituitary tumor (also known as pituitary adenomas). Large tumors or macroadenomas are usually associated with apoplexy and the term apoplexy refers to large bleeds associated with sudden onset of symptoms. If prompt diagnosis and treatment are administered, this condition is rarely life-threatening.

In most cases, the patient becomes aware of a benign tumor after the onset of pituitary apoplexy. Some factors have been associated with onset of pituitary apoplexy and these include high blood pressure, head injury, pregnancy, major surgery, use of blood thinning medications and a history of radiation therapy to the pituitary gland. Only in a few extremely rare cases has apoplexy occurred in people without the presence of a pituitary tumor and an associated sudden and severe drop in blood pressure.

The symptoms of this condition include sudden onset of severe headache located behind the eyes or around the temples, nausea and vomiting, rapidly worsening visual field impairment including double vision, decreased consciousness, neck rigidity and paralysis affecting movements of the eye. All these are due to compression of nerves around the gland. With time, other symptoms may also develop as a result of the pituitary glands inability to produce some hormones.

Diagnosis includes an initial assessment including a detailed history with emphasis on symptoms that may indicate improper functioning of the pituitary gland; next will be a physical exam including a study of the visual field and cranial nerves. An MRI and/or a CT scan are next in line which will be confirmatory of the apoplexy. Additional blood tests are also conducted to check if the pituitary is producing the right hormones and quantities.

Treatment involves an initial stabilization of the patient with high dose corticosteroid shots and careful monitoring of fluids and electrolyte levels. In most cases, surgery is carried out through the nose using the endoscopic endonasal technique to minimize complications and discomfort. After surgery, the patient is carefully monitored for hormonal deficiencies to check if the function of the pituitary gland is affected, and whether any long-term hormone replacement is required. Sadly, majority of patients end up needing hormone supplementation for life and need to go for annual reviews.

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