pituitary apoplexy

Summary

Summary: The sudden loss of blood supply to the PITUITARY GLAND, leading to tissue NECROSIS and loss of function (PANHYPOPITUITARISM). The most common cause is hemorrhage or INFARCTION of a PITUITARY ADENOMA. It can also result from acute hemorrhage into SELLA TURCICA due to HEAD TRAUMA; INTRACRANIAL HYPERTENSION; or other acute effects of central nervous system hemorrhage. Clinical signs include severe HEADACHE; HYPOTENSION; bilateral visual disturbances; UNCONSCIOUSNESS; and COMA.

Top Publications

  1. Satyarthee G, Mahapatra A. Pituitary apoplexy in a child presenting with massive subarachnoid and intraventricular hemorrhage. J Clin Neurosci. 2005;12:94-6 pubmed
    A case of pituitary apoplexy in a child with massive subarachnoid and intraventricular hemorrhage is reported. The patient presented with a sudden onset of headache, diminution of visual acuity and a bitemporal visual field defect...
  2. Okawara M, Yamaguchi H, Hayashi S, Matsumoto Y, Inoue Y, Okawara S. [A case of ruptured internal carotid artery aneurysm mimicking pituitary apoplexy]. No Shinkei Geka. 2007;35:1169-74 pubmed
    ..findings suggested the rupture of a de novo aneurysm causing a hemorrhage into a pituitary adenoma mimicking pituitary apoplexy. Endovascular occlusion of the aneurysm was performed by use of platinum coils...
  3. Semple P, Webb M, de Villiers J, Laws E. Pituitary apoplexy. Neurosurgery. 2005;56:65-72; discussion 72-3 pubmed
    b>Pituitary apoplexy is a rare yet potentially fatal disease...
  4. Dubuisson A, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg. 2007;109:63-70 pubmed
    ..clinical presentation, endocrinological and radiological findings, medical and surgical management of pituitary apoplexy in our department (single-centre study), having a large experience in pituitary surgery...
  5. Lubina A, Olchovsky D, Berezin M, Ram Z, Hadani M, Shimon I. Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochir (Wien). 2005;147:151-7; discussion 157 pubmed
    b>Pituitary apoplexy is a rare major clinical event with neurological, neuro-ophthalmological, cardiovascular and hormonal consequences, resulting from an acute infarction of pituitary adenoma...
  6. Valente M, Marroni M, Stagni G, Floridi P, Perriello G, Santeusanio F. Acute sterile meningitis as a primary manifestation of pituitary apoplexy. J Endocrinol Invest. 2003;26:754-7 pubmed
    b>Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland...
  7. Sani S, Smith A, Leppla D, Ilangovan S, Glick R. Epidermoid cyst of the sphenoid sinus with extension into the sella turcica presenting as pituitary apoplexy: case report. Surg Neurol. 2005;63:394-7; discussion 397 pubmed
    ..The significance of the clinical presentation resembling pituitary apoplexy and magnetic resonance imaging (MRI) findings is noted.
  8. Liu J, Couldwell W. Pituitary apoplexy in the magnetic resonance imaging era: clinical significance of sphenoid sinus mucosal thickening. J Neurosurg. 2006;104:892-8 pubmed
    The authors report their experience with pituitary apoplexy and evaluate the clinical significance of sphenoid sinus mucosal thickening found on magnetic resonance (MR) imaging...
  9. Suzuki H, Muramatsu M, Murao K, Kawaguchi K, Shimizu T. Pituitary apoplexy caused by ruptured internal carotid artery aneurysm. Stroke. 2001;32:567-9 pubmed
    We report the first case of pituitary apoplexy caused by the rupture of an intracavernous carotid artery aneurysm embedded in a pituitary adenoma. A 46-year-old man presented with clinical and CT findings typical of pituitary apoplexy...

More Information

Publications62

  1. Murad Kejbou S, Eggenberger E. Pituitary apoplexy: evaluation, management, and prognosis. Curr Opin Ophthalmol. 2009;20:456-61 pubmed publisher
    To review the current standard of care in the diagnosis and treatment of pituitary apoplexy and to determine any updated clinical management strategies. Pituitary apoplexy is a rare but life-threatening medical emergency...
  2. Liu Z, Chang C, Pai P, Wei K, Jung S, Chen N, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. 2010;17:694-9 pubmed publisher
    The clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. Clinical symptomatic pituitary apoplexy is a well-described syndrome characterized by sudden headaches, visual impairment, hypopituitarism and, at times,..
  3. Lath R, Rajshekhar V. Massive cerebral infarction as a feature of pituitary apoplexy. Neurol India. 2001;49:191-3 pubmed
    A patient with pituitary apoplexy is reported who, in addition to the clinical features of apoplexy, developed a cerebral infarct secondary to compression of the internal carotid artery...
  4. Agrawal D, Mahapatra A. Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surg Neurol. 2005;63:42-6; discussion 46 pubmed
    To study the visual outcome of patients who became blind after an episode of pituitary apoplexy and who subsequently underwent emergency transsphenoidal decompression of the optic apparatus, and to identify factors that may have a bearing ..
  5. Sud R, Greval R, Sud M. Sudden blindness from pituitary apoplexy: a report of two cases. Indian J Med Sci. 1993;47:180-2 pubmed
    Two cases of acidophil adenoma of the pituitary causing sudden blindness from pituitary apoplexy are presented. The tumours had been clinically silent, without producing any symptoms of endocrine dysfunction...
  6. Chokyu I, Tsuyuguchi N, Goto T, Chokyu K, Chokyu M, Ohata K. Pituitary apoplexy causing internal carotid artery occlusion--case report. Neurol Med Chir (Tokyo). 2011;51:48-51 pubmed
    A 50-year-old man presented with pituitary apoplexy resulting in internal carotid artery occlusion manifesting as sudden onset of severe headache, right ptosis, and left hemiparesis, associated with visual impairment...
  7. Lau K, Joshi S, Ellamushi H, Afshar F. Isolated bilateral oculomotor nerve palsy in pituitary apoplexy: case report and review. Br J Neurosurg. 2007;21:399-402 pubmed
    ..We report a case of a pituitary adenoma presenting with complete, bilateral oculomotor nerve palsies, but minimal loss of visual fields, and intact abducens and trochlear nerves. ..
  8. Watt A, Pobereskin L, Vaidya B. Pituitary apoplexy within a macroprolactinoma. Nat Clin Pract Endocrinol Metab. 2008;4:635-41 pubmed publisher
    ..b>Pituitary apoplexy within a macroprolactinoma...
  9. Akutsu H, Noguchi S, Tsunoda T, Sasaki M, Matsumura A. Cerebral infarction following pituitary apoplexy--case report. Neurol Med Chir (Tokyo). 2004;44:479-83 pubmed
    ..Magnetic resonance (MR) imaging showed the typical findings of pituitary apoplexy, and cerebral angiography disclosed mild narrowing of the A1 segment of the left anterior cerebral artery (..
  10. Zayour D, Selman W, Arafah B. Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metab. 2004;89:5649-54 pubmed
    ..A normal or elevated serum PRL level in patients with non-PRL-secreting macroadenomas indicates the presence of viable pituitary cells and the high likelihood of postoperative recovery of pituitary function. ..
  11. Błaut K, Wisniewski P, Syrenicz A, Sworczak K. Apoplexy of clinically silent pituitary adenoma during prostate cancer treatment with LHRH analog. Neuro Endocrinol Lett. 2006;27:569-72 pubmed
    ..Neurological impairment resolved within 9 months after the operation. As a result the patient required adrenal and thyroid replacement. During 6 years of follow-up there was no evidence of prostate cancer recurrence. ..
  12. Asari S, Gotoh M, Nishimoto A. Typical blood-fluid level formation on computerized tomogram in pituitary apoplexy: case report. Comput Med Imaging Graph. 1990;14:147-8 pubmed
    A rare case of the pituitary apoplexy was presented in this paper. Computerized tomography clearly showed a blood-fluid level in the pituitary adenoma.
  13. Torres A, Dammers R, Krisht A. Bilateral internal carotid artery aneurysm simulating pituitary apoplexy: case report. Neurosurgery. 2009;65:E1202; discussion E1202 pubmed publisher
    ..However, they are rarely associated with pituitary apoplexy. We present a rare case of bilateral intracavernous ICA aneurysms simulating a sellar mass with the clinical ..
  14. Turgut M, Ozsunar Y, Basak S, Guney E, Kir E, Meteoglu I. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir (Wien). 2010;152:749-61 pubmed publisher
    b>Pituitary apoplexy is a rare and life-threatening complication occurring in 0.6-10.5% of all cases of pituitary adenomas...
  15. Engel G, Huston M, Oshima S, Beck C, Harsh G, Rosenthal M, et al. Pituitary apoplexy after leuprolide injection for ovum donation. J Adolesc Health. 2003;32:89-93 pubmed
    Patients with occult pituitary adenomas infrequently present with pituitary apoplexy. Precipitation of pituitary apoplexy by gonadotropin releasing hormone or gonadotropin releasing hormone agonists has been described...
  16. Brouns R, Crols R, Engelborghs S, De Deyn P. Pituitary apoplexy presenting as chemical meningitis. Lancet. 2004;364:502 pubmed
  17. Soni A, De Silva S, Allen K, Byrne J, Cudlip S, Wass J. A case of macroprolactinoma encasing an internal carotid artery aneurysm, presenting as pituitary apoplexy. Pituitary. 2008;11:307-11 pubmed
    ..The diagnosis and management of this condition was challenging and the final outcome, with non-surgical treatment and carotid artery occlusion was satisfactory...
  18. Chuang C, Chang C, Wei K, Liao C, Hsu P, Huang Y, et al. Surgical treatment for severe visual compromised patients after pituitary apoplexy. J Neurooncol. 2006;80:39-47 pubmed
    b>Pituitary apoplexy is a rare neurovascular insult. Early surgical decompression is the most effective treatment, especially for rapid deterioration of visual acuity or for altered consciousness...
  19. Semple P, de Villiers J, Bowen R, Lopes M, Laws E. Pituitary apoplexy: do histological features influence the clinical presentation and outcome?. J Neurosurg. 2006;104:931-7 pubmed
    A retrospective analysis of a contemporary series of patients with pituitary apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome...
  20. Davis A, Goel S, Picolos M, Wang M, Lavis V. Pituitary apoplexy after leuprolide. Pituitary. 2006;9:263-5 pubmed
    ..of a 61-year-old male patient with locally advanced prostate cancer who presented with an acute picture of pituitary apoplexy after his first dose of leuprolide...
  21. Iwai Y, Yamanaka K, Ishiguro T, Morikawa T, Matsuzaka Y, Komiyama M, et al. [Results of treatment for male prolactinomas]. No Shinkei Geka. 2002;30:1285-92 pubmed
    ..years old (mean 43 years) and the chief clinical symptoms were visual acuity/field defect in three patients, pituitary apoplexy in one patient, disturbance of ejection in one patient, generalized convulsion in one patient, headache in ..
  22. Lwin T, Leigh N, Iskandar M, Steele J, Wayne M, Cooperman A. Rare, Uncommon, and Unusual Complications After Pancreaticoduodenal Resection. Surg Clin North Am. 2018;98:87-94 pubmed publisher
    ..Rare systemic complications after PDR (Transfusion transmitted Babesiosis, pituitary apoplexy, and TRALI) and a number of uncommon and unusual other complications are discussed...
  23. Rogg J, Tung G, Anderson G, Cortez S. Pituitary apoplexy: early detection with diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2002;23:1240-5 pubmed
    b>Pituitary apoplexy is defined as a clinical syndrome that may include headache, visual deficits, ophthalmoplegia, or altered mental status. It may result from either infarction or hemorrhage of the pituitary gland...
  24. Dev R, Singh S, Sharma M, Khetan P, Chugh A. Post traumatic pituitary apoplexy with contiguous intra cerebral hematoma operated through endonasal route--a case report. Pituitary. 2007;10:291-4 pubmed
    b>Pituitary apoplexy is a clinical syndrome occurring as a consequence of fulminant expansion of pituitary tumor due to massive infarction, necrosis, and hemorrhage...
  25. Witek P, Zielinski G, Maksymowicz M, Zgliczynski W. Transsphenoidal surgery for a life-threatening prolactinoma apoplexy during pregnancy. Neuro Endocrinol Lett. 2012;33:483-8 pubmed
    ..The patient is kept under constant medical care. In this case study the authors discussed therapeutic management and reviewed literature regarding gestational pituitary-tumor apoplexy with particular emphasis on surgical treatment. ..
  26. Sung C, Suh Y, Lee D. Extensive spherical amyloid deposition of pituitary adenoma presenting as pituitary apoplexy. Clin Neurol Neurosurg. 2008;110:424-5 pubmed publisher
  27. Kim H, Cho W. Optic tract hemorrhage after pituitary apoplexy. AJNR Am J Neuroradiol. 2007;28:141-2 pubmed
    Subarachnoid hemorrhage following pituitary apoplexy is rare, and optic tract hemorrhage after the apoplexy is extremely rare. We report a case of optic tract hemorrhage after apoplexy that is not associated with hematologic disorders.
  28. Orakdöğeny M, Karadereler S, Berkman Z, Ersahin M, Ozdogan C, Aker F. Intra-suprasellar meningioma mimicking pituitary apoplexy. Acta Neurochir (Wien). 2004;146:511-5 pubmed
    ..It is emphasized that this unusual tumour can mimic pituitary apoplexy. Differential diagnosis and surgical treatment of intrasellar meningioma versus pituitary adenoma are ..
  29. Shirakawa J, Takeshita T, Miyao M, Orimo S, Terauchi Y, Mizuno Y. Pituitary abscess with panhypopituitarism showing T1 signal hyperintensity of the marginal pituitary area: a non-invasive differential diagnosis of pituitary abscess and pituitary apoplexy. Intern Med. 2009;48:441-6 pubmed
    ..Pituitary abscess was primarily suspected on MR imaging findings, although it was difficult to differentiate pituitary apoplexy by MR imaging findings, alone...
  30. Chentli F, Bey A, Belhimer F, Azzoug S. Spontaneous resolution of pituitary apoplexy in a giant boy under 10 years old. J Pediatr Endocrinol Metab. 2012;25:1177-9 pubmed
    Pituitary gigantism is a very rare condition; the occurrence of pituitary apoplexy in children younger than 10 years old is even rarer. The aim of our study is to report this exceptional association...
  31. Matti A, Rudkin A, Lee A, Chen C. Isolated unilateral abducens cranial nerve palsy: a rare presentation of pituitary apoplexy. Eur J Ophthalmol. 2010;20:234-6 pubmed
    To describe a rare presentation of pituitary apoplexy as unilateral abducens nerve palsy demonstrating the various presentations of the condition. Case report. A 48-year-old man presented with isolated right abducens nerve palsy...
  32. Hutchinson D, Avery S. Pituitary apoplexy. N Z Med J. 1989;102:158-60 pubmed
    b>Pituitary apoplexy, a rare neurological emergency resulting from pituitary haemorrhage or infarction, should be considered a possibility in patients presenting with headache. Six cases are reported...
  33. Wang H, Huang C, Chen Y, Ho D, Lin H. Pituitary apoplexy after thyrotropin-releasing hormone stimulation test in a patient with pituitary macroadenoma. J Chin Med Assoc. 2007;70:392-5 pubmed
    b>Pituitary apoplexy is a rare complication of pituitary tumors...
  34. Levy A. Hazards of dynamic testing of pituitary function. Clin Endocrinol (Oxf). 2003;58:543-4 pubmed
  35. Ntali G, Wass J. Epidemiology, clinical presentation and diagnosis of non-functioning pituitary adenomas. Pituitary. 2018;21:111-118 pubmed publisher
    ..and hypopituitarism but also hyperprolactinaemia due to pituitary stalk deviation and less frequently pituitary apoplexy. Non-functioning pituitary incidentalomas are found on brain imaging performed for an unrelated reason...
  36. Famularo G, Pozzessere C, Piazza G, De Simone C. Abrupt-onset oculomotor paralysis: an endocrine emergency. Eur J Emerg Med. 2001;8:233-6 pubmed
    b>Pituitary apoplexy is a severe and potentially life-threatening condition that may be highly variable in its clinical presentation...
  37. Alzetani A, Fisher C, Costa R, Ohri S. Ptosis postcardiac surgery: a case of pituitary apoplexy. Ann Thorac Surg. 2002;73:300-1 pubmed
    We present a patient in whom ptosis and third cranial nerve palsy developed postcoronary artery bypass grafting, and discuss the management of pituitary apoplexy postcardiac surgery.
  38. Nagarajan D, Bird D, Papouchado M. Pituitary apoplexy following anticoagulation for acute coronary syndrome. Heart. 2003;89:10 pubmed
  39. Gruber A, Clayton J, Kumar S, Robertson I, Howlett T, Mansell P. Pituitary apoplexy: retrospective review of 30 patients--is surgical intervention always necessary?. Br J Neurosurg. 2006;20:379-85 pubmed
    The objective of this article is to review clinical outcomes in patients presenting with pituitary apoplexy and compare the results of conservative and surgical management...
  40. Rajasekaran S, Vanderpump M, Baldeweg S, Drake W, Reddy N, Lanyon M, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf). 2011;74:9-20 pubmed publisher
    Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving...
  41. Barabash R, Moreno Suárez F, Rodriguez L, Molina A, Conejo Mir J. [Nelson syndrome: a rare cause of generalized hyperpigmentation of the skin]. Actas Dermosifiliogr. 2010;101:76-80 pubmed
    ..As this operation has fallen into disuse, Nelson syndrome is now extremely rare and difficult to recognize. We present a very severe case of generalized hyperpigmentation due to Nelson syndrome in a 37-year-old woman...
  42. Jan M, Dufour H, Brue T, Jaquet P. Prolactinoma surgery. Ann Endocrinol (Paris). 2007;68:118-9 pubmed
    ..A transsphenoidal or, less frequently, a transfrontal surgical approach is necessary in patients resistant to or intolerant of medical treatment, and also in rare cases such as pituitary apoplexy or cerebrospinal fluid rhinorrhea.
  43. Fujii T, Kohno Y, Nishiyama T. [Anesthesia for open reduction of ankle fracture in a patient with giant pituitary adenoma]. Masui. 2013;62:1440-2 pubmed
    A few cases of the pituitary apoplexy have been reported after spinal anesthesia in patients with pituitary tumor. A patient with giant pituitary adenoma underwent open reduction of the ankle fracture...
  44. Sussman E, Ho A, Pendharkar A, Achrol A, Harsh G. Pituitary Apoplexy Associated with Carotid Compression and a Large Ischemic Penumbra. World Neurosurg. 2016;92:581.e7-581.e13 pubmed publisher
    b>Pituitary apoplexy is an acute clinical syndrome caused by pituitary gland hemorrhage or infarction. Rarely, this clinical syndrome is associated with cerebral infarction secondary to compression of an internal carotid artery...
  45. Simó O, Castells I, Recasens A, Yetano V. [Pituitary apoplexy following treatment for acute coronary syndrome]. Med Clin (Barc). 2006;127:477 pubmed
  46. Acar F, Mertol T. Pituitary apoplexy following laparascopic cholocystectomy. Acta Neurochir (Wien). 2004;146:1275-6 pubmed
  47. Santos A, França M, Hirosawa R, Marivo M, Zanini M, Nunes V. Conservative management of pituitary tumor apoplexy. Arq Bras Endocrinol Metabol. 2011;55:345-8 pubmed
    ..We describe two patients with pituitary tumor apoplexy who had clinically non-functioning macroadenomas and hypopituitarism, including hypogonadism. They were treated conservatively without surgery, and achieved tumor remission. ..
  48. Tuna H, Torun F, Torun A, Erdogan A. Intrasellar epidermoid cyst presenting as pituitary apoplexy. J Clin Neurosci. 2008;15:1154-6 pubmed publisher
    We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach...
  49. Laws E. Pituitary tumor apoplexy: a review. J Intensive Care Med. 2008;23:146-7 pubmed publisher
  50. Lill C, Hoch H, Dieste F, Vogel H, Zipp F, Paul F. Bilateral stroke following pituitary apoplexy. J Clin Neurosci. 2009;16:1670-3 pubmed publisher
    b>Pituitary apoplexy followed by cerebral infarction is rare. We report a 59-year-old male with a known pituitary macroadenoma who was admitted to our emergency department for treatment of an acute myocardial infarction...
  51. Haviv Y, Goldschmidt N, Safadi R. Pituitary apoplexy manifested by sterile meningitis. Eur J Med Res. 1998;3:263-4 pubmed
    b>Pituitary apoplexy is rare and underdiagnosed. It results from either infarction or hemorrhage into an adenoma of the pituitary gland...
  52. Balak N, Aras A, Isik N, Elmaci I. [Making the differential diagnosis between pituitary apoplexy and craniopharyngioma]. Neurochirurgie. 2009;55:600-2 pubmed publisher
    b>Pituitary apoplexy is characterized by an abrupt neurological deteriorating condition associated with rapid expansion of the pituitary gland, caused by ischemic necrosis and hemorrhage...
  53. Pawar S, Sharma R, Lad S, Dev E, Devadas R. Rathke's cleft cyst presenting as pituitary apoplexy. J Clin Neurosci. 2002;9:76-9 pubmed
    ..authors present an interesting case of intrasellar Rathke's pouch cyst, with a presenting feature of acute pituitary apoplexy. This was a 19 year old healthy male who had developed sudden headache and visual disturbance...