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March 27, 2017 E-Pearl of the Week: Clinical manifestations of pituitary apoplexy

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March 27, 2017

Clinical manifestations of pituitary apoplexy

Pituitary apoplexy refers to an infarction or hemorrhage into the pituitary gland, often in in the setting of an adenoma. This can result in the rapid expansion of the pituitary gland. Clinical manifestations include nausea, vomiting, ophthalmoplegia resulting in diplopia, and vision loss. Acute onset of severe headache is the most frequent presenting symptom. In addition, apoplexy can produce hypopituitarism with resulting electrolytic disturbances or adrenal crisis. Often the adenoma is undiagnosed prior to apoplexy. Thus, there should be a high index of suspicion for apoplexy with any patient presenting with thunderclap headache, third cranial nerve palsies or vision loss, and signs of hypopituitarism. Patients with a known, previously stable adenoma should be evaluated for apoplexy if they present suffering from sudden onset severe headache with this constellation of findings. Management is controversial due to the limited available data on treatment and outcomes for this rare phenomenon. Early administration of corticosteroids is indicated and decisions regarding conservative management versus emergent neurosurgical intervention depend on the severity of symptoms.

Reference:

  1. Capatina C, Inder W, Karavitaki N, Wass JA.  Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol 2015; 172: R179-R190.
  2. Dodick DW, Wijdicks EF. Pituitary apoplexy presenting as a thunderclap headache. Neurology 1998; 50: 1510-1511.

Submitted by Daniel Corbally, Medical Student - Lewis Katz School of Medicine at Temple University, and Kandan Kulandaivel, MD - Department of Neurosciences, Abington Hospital. Daniel Corbally and Dr. Kulandaivel report no disclosures.

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