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Pituitary apoplexy

Pituitary apoplexy is the death of an area of tissue in the pituitary gland.

Alternative Names

Pituitary infarction

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 is commonly caused by bleeding inside a noncancerous tumor of the pituitary. When pituitary bleeding occurs in a woman during or right after childbirth, it is called Sheehan syndrome .

Risk factors for pituitary apoplexy include:

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

In most cases, the cause is not clear.

Symptoms

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

  • Severe headache
  • Paralysis of the eye muscles, causing double vision (ophthalmoplegia )
  • Low blood pressure, nausea, 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 usually not necessary.

Immediate treatment with adrenal replacement hormones (glucocorticoids) is needed. Other hormones will be replaced, including:

  • Growth hormone
  • Sex hormones (estrogen/testosterone)
  • Thyroid hormone

Outlook (Prognosis)

Acute pituitary apoplexy can be life-threatening. The outlook is good for people who have 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
  • 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. 12th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 9.

Murad-Kejbou S. Pituitary apoplexy: evaluation, management, and prognosis. Curr Opin Ophthalmol. 2009;20: 456-461.

Updated: 11/7/2013

Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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