What is Pituitary Apoplexy?

Pituitary apoplexy is a possible complication of a benign pituitary tumor, called an adenoma. Problems occur when an adenoma begins to bleed or cause tissue death in the gland. The result is an extreme hormone imbalance that can lead to many symptoms, including vision loss, massive headaches, nausea, and vomiting. Pituitary apoplexy can be life-threatening if it is not diagnosed and treated right away. It is essential for patients who know they have pituitary tumors to seek emergency care whenever apoplexy symptoms arise to ensure quick, effective treatment with medications or surgery.

It is not always clear what causes pituitary apoplexy, but doctors have identified several risk factors in people who have adenomas. Research suggests that hemorrhaging and tissue death are most likely to occur when an adenoma outgrows its blood supply. Without enough nutrients from blood, the mass of tissue and surrounding areas in the gland begin to die and stop producing important hormones. Underlying bleeding disorders, head trauma, and diabetes are present in many cases. In addition, radiation treatment for a tumor may increase the likelihood of spontaneous bleeding.

In most cases, symptoms of pituitary apoplexy come about suddenly. A person can experience a quickly worsening headache, nausea, vomiting, and fatigue. The eyes are often affected, leading to blurred or double vision, throbbing pains, and occasionally paralysis of one or both eyes. Without treatment, hormone imbalances and hemorrhaging can result in extreme fatigue, heart rate issues, fainting, stroke, or sudden death.

Doctors can diagnose pituitary apoplexy by carefully examining all of a patient's symptoms and reviewing his or her medical history. If the patient is stable, magnetic resonance imaging scans can be taken of the brain to confirm hemorrhaging and other abnormalities. Blood tests are also important to determine the severity and types of hormone problems that have resulted from apoplexy.

The immediate goal of treatment is to balance hormone levels and stabilize vital signs. Patients may need corticosteroid injections, intravenous blood pressure medications, and oxygen therapy in the intensive care unit. Surgery is necessary in most cases to prevent symptoms from returning or worsening. The procedure involves careful removal of the tumor and dead tissue when possible, and occasionally the removal of the entire pituitary gland. The outlook for patients depends on several factors, but the majority of people are able to recover as long as they attend regular screenings and take daily hormone medications as prescribed by their doctors.