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Pituitary apoplexy

  • Definition
    • Pituitary apoplexy is a rare, but serious condition of the pituitary gland.

  • Alternative Names
    • Pituitary infarction; Pituitary tumor apoplexy

  • Causes
    • The pituitary is a small gland at the base of the brain. The pituitary produces many of the hormones that control essential body processes.

      Pituitary apoplexy can be caused by bleeding into the pituitary or by blocked blood flow of the pituitary. Apoplexy means bleeding into an organ or loss of blood flow to an organ.

      Pituitary apoplexy is commonly caused by bleeding inside a noncancerous (benign) tumor of the pituitary. The pituitary is damaged when the tumor suddenly enlarges and either bleeds into the pituitary or blocks blood supply to the pituitary.

      When pituitary bleeding occurs in a woman during or right after childbirth, it is called Sheehan syndrome. This is a very rare condition.

      Risk factors for pituitary apoplexy in non-pregnant people without a tumor include:

      • Bleeding disorders
      • Diabetes
      • Head injury
      • Radiation to the pituitary gland
      • Use of a breathing machine

      Pituitary apoplexy in these situations is very rare.

  • Symptoms
    • Pituitary apoplexy usually has a short period of symptoms (acute), which can be life threatening. Symptoms often include:

      • Severe headache (worst of your life)
      • Paralysis of the eye muscles, causing double vision (ophthalmoplegia) or problems opening an eyelid
      • Low blood pressure, nausea, loss of appetite, and vomiting from acute adrenal insufficiency
      • Personality changes due to sudden narrowing of one of the arteries in the brain (anterior cerebral artery)

      Less commonly, pituitary dysfunction may appear more slowly. In Sheehan syndrome, for example, the first symptom may be a failure to produce milk caused by a lack of the hormone prolactin.

      Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions:

      In rare cases, when the posterior (back part) of the pituitary is involved, symptoms may include:

      • Failure of the uterus to contract to give birth to a baby (in women)
      • Failure to produce breast milk (in women)
      • Frequent urination and severe thirst
  • Exams and Tests
    • The doctor will perform a physical exam and ask about your symptoms.

      Tests that may be ordered include:

      Blood tests will be done to check levels of:

  • Treatment
    • Acute apoplexy may require surgery to relieve pressure on the pituitary and improve vision symptoms. Severe cases need emergency surgery. If vision is not affected, surgery is often not necessary.

      Immediate treatment with adrenal replacement hormones (glucocorticoids) is needed. These hormones are often given through the vein (by IV). Other hormones may eventually be replaced, including:

      • Growth hormone
      • Sex hormones (estrogen/testosterone)
      • Thyroid hormone
      • Vasopressin (ADH)
  • Outlook (Prognosis)
    • Acute pituitary apoplexy can be life threatening. The outlook is good for people who have long-term (chronic) pituitary deficiency that is diagnosed and treated.

  • Possible Complications
    • Complications of untreated pituitary apoplexy can include:

      If other missing hormones are not replaced, symptoms of hypothyroidism and hypogonadism may develop.

  • When to Contact a Medical Professional
    • Call your health care provider if you have any symptoms of chronic pituitary insufficiency.

      Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of acute pituitary apoplexy, including:

      • Eye weakness or vision loss
      • Sudden, severe headache
      • Low blood pressure (which can cause fainting)
      • Nausea
      • Vomiting

      If you develop these symptoms and you have already been diagnosed with a pituitary tumor, seek medical help right away.

  • References
    • Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 9.

      Nelson BK. Pituitary apoplexy. In: Adams JG, ed. Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 170.