Pituitary apoplexy is bleeding into or impaired blood supply of the pituitary gland.This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously.The most common initial symptom is a sudden headache, often associated with a rapidly worsening visual field defect or double vision caused by compression of nerves surrounding the gland.
Accessed on April 24, 2014Linde K, Allais G, Brinkhaus B, et al. If there is any deterioration, or expected spontaneous improvement does not occur, surgical intervention may still be indicated.After recovery, people who have had pituitary apoplexy require follow-up by an In larger case series, the mortality was 1.6% overall.
The diplopia may be present constantly or intermittently.As described above, extraocular muscle paresis is a rare presentation (~5% of patients with pituitary adenoma) most often associated with a concurrent palsy of the corresponding cranial nerve.
For example, ovarian apoplexy is bleeding in the ovaries. Headaches can occur as a result of many conditions. Fernández-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, Ponce de León-Lovatón PG, Erwin PJ, Carey J, Montori VM. Reddy R, Cudlip S, Byrne JV, Karavitaki N, Wass JA. Müslüman AM, Cansever T, Yılmaz A, Kanat A, Oba E, Çavuşoğlu H, Sirinoğlu D, Aydın Y. Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes. A classification tree approach for pituitary adenomas.
While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Nelson syndrome describes the enlargement of an ACTH-secreting pituitary adenoma following surgical removal of the adrenal glands for treating Cushing syndrome. Less commonly, ophthalmologists may be the first to detect evidence of a pituitary adenoma. Thyrotrophic adenomas will usually induce a hyperthyroid state due to the high levels of TSH, however hypo and euthyroidism is also possible.An adenoma expressing more than one pituitary hormone is considered a plurihormal pituitary adenoma, except in the instances of dual GH and PRL, and FSH and LH expression. Interestingly, monocular temporal (uncrossed fibers) or nasal (crossed fibers) hemanopic visual field loss can also occur from a lesion at the junction of the optic nerve and chiasm.
Ergotamine is useful if given 1–2 hours before an attack.Treatment of secondary headaches involves treating the underlying cause.
Some are harmless and some are Headaches are broadly classified as "primary" or "secondary".90% of all headaches are primary headaches. 61.Leon Barnes: Pathology and genetics of head and neck tumours; p.100: World Health Organization; (2005) Daniel R. Fassett, M.D. The top, one-digit diagnostic level includes 14 headache groups. The pain receptors may be stimulated by head trauma or tumors and cause headaches. They may also develop hyperpigmentation, which occurs due to the stimulation of melanocytes by POMC. Amongst the types of headaches experienced are both chronic and episodic Compressive symptoms of pituitary adenomas (visual field deficits, decreased visual acuity, headaches) are more commonly seen with macroadenomas (which are greater than 10 mm in diameter) than with microadenomas (which are less than 10 mm in diameter).Non-secreting adenomas can go undetected for an extended time because no obvious abnormalities are seen; the gradual reduction in normal activities due to decreased production of hormones is rather less evident.
Kawasaki A, Purvin VA. Photophobia as the Pituitary apoplexy must be differentiated from other diseases that cause severe headache such as subarachnoid hemorrhage, meningitis, intracranial mass, cerebral hemorrhage, cerebral infarction, intracranial venous thrombosis, migraine, head injury, and lymphocytic hypophysitis. Patients will often complain that they have trouble with anteroposterior tasks such as cutting fingernails, threading needles, and working with precision tools.Pulfrich phenomenon is a test for stereopsis, non-specific to chiasmal compression.Diplopia may be due to a paretic diplopia from ocular motor cranial nerve (e.g., III, IV, VI) paresis from lateral extension of tumors into the cavernous sinus, or a non-pareteic diplopia as a result of "hemifield slide" (described below). This has been termed "post-fixational blindness", and is caused by the two blind temporal hemifields overlapping during convergence. Some patients with complete bitemporal hemianopsia will complain of a complete loss of depth perception. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Pituitary apoplexy ultrasound On the Web Most recent articles. Pituitary apoplexy is an important entity for general ophthalmologists to be familiar with because patients with this condition may initially present visual dysfunction. The term formerly referred to what is now called a stroke; nowadays, health care professionals typically specify the type of apoplexy, such as cerebral, ovarian and pituitary apoplexy. Practical Pituitary Pathology: what does the pathologist need to know? For example, insufficient Various psychiatric manifestations have been associated with pituitary disorders including pituitary adenomas.
The visual loss can be due to a unilateral or bilateral optic neuropathy, bitemporal hemianopsia from chiasmal compression, or rarely homonymous hemianopsia from optic tract involvement. As such, they tend to become symptomatic when they grow large enough to cause the associated neurological symptoms of pituitary tumors.
Personnier C, Cazabat L, Bertherat J, Gaillard S, Souberbielle JC, Habrand JL, Dufour C, Clauser E, SainteRose C, Polak M. Clinical features and treatment of pediatric somatotropinoma: case study of an aggressive tumor due to a new AIP mutation and extensive literature review.
Pituitary apoplexy is an acute clinical syndrome caused by either haemorrhagic or non-haemorrhagic necrosis of the pituitary gland .
; William T. Couldwell, M.D., PhD;