pituitary apoplexy

Last reviewed 01/2018

Pituitary apoplexy results from haemorrhage or infarction of the pituitary in 1-10% of patients with pituitary adenomas (1).

Pituitary apoplexy has very rarely been described during pregnancy, when it is potentially life-threatening to both the mother and the fetus (2).

It is characterised by:

  • severe headache of acute onset, similar to that in subarachnoid haemorrhage
  • neck stiffness may be present
  • rapidly progressive visual impairment
  • extraocular nerve palsies
  • primary pituitary insufficiency
  • stupor and then coma

Steroid cover - iv. hydrocortisone, attention to fluid balance, and early transphenoidal surgery are necessary.

Survivors require lifelong replacement therapy for the resultant hypopituitarism.