Neurosurgical Diseases and Disorders (M-Z) / Pituitary Apoplexy

General Information

• Pituitary apoplexy occurs when a pituitary tumor spontaneously hemorrhages (bleeds) or when it outgrows its blood supply. This loss of blood supply can cause tumor cell death, bleeding and acute tumor swelling. The relatively sudden change in tumor size causes compression of the normal pituitary gland, the optic nerves and the nerves that control eye movements.
• All types of pituitary adenomas can be associated with apoplexy, particularly larger tumors (macroadenomas).
• There are no clear predisposing factors for developing pituitary apoplexy, although it has been associated with a wide range of disorders and treatment side effects.

Symptoms

• Symptoms often include headache, nausea, visual loss and double vision.
• If bleeding extends into the cerebrospinal fluid spaces, severe headache, neck stiffness and fever may occur.
• Most patients also have undiagnosed hormone insufficiency. 

Diagnosis

• Pituitary apoplexy is best diagnosed with a magnetic resonance imaging (MRI) scan of the brain, with special attention to the pituitary. A computerized tomography (CT) scan of the pituitary gland also shows an abnormality in most cases.

Treatment

• Effective treatment of pituitary apoplexy requires rapid administration of high-dose corticosteroid, careful monitoring of fluid and electrolyte levels and, in most cases, urgent transsphenoidal surgery.
• Treatment with bromocriptine or cabergoline can be used instead of surgery in a few patients with minor symptoms and large prolactinomas.
• Careful monitoring of hormonal status by an endocrinologist during the acute phase of apoplexy and in the recovery phase is essential.

Outcome

• Thanks to the advent of steroid medications, patients today rarely die from pituitary apoplexy if promptly diagnosed and treated.
• Most patients have significant visual improvement after surgery; however, a majority will have permanent hormone deficiencies due to pituitary injury. These deficiencies require hormone replacement therapy for life.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide