Abstract
The classical term “pituitary apoplexy” (PA) describes a clinical syndrome usually
characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic
deterioration due to sudden expansion of a mass within the sella turcica as a result
of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland.
PA is a medical emergency and a difficult diagnosis to establish. Thus this article
reviews the presenting symptoms of PA patients to help clinicians recognize or at
least suspect this critical condition early on. PA commonly occurs in the setting
of a preexisting adenoma, and several patients are unaware of its existence prior
to the onset of apoplexy symptoms, which are mainly of a neurologic, ophthalmologic,
and endocrinologic nature. Neurologic symptoms include sudden-onset severe headache
and other symptoms of subarachnoid hemorrhage, symptoms from compression of the cavernous
sinus contents, nausea/vomiting, impaired consciousness, and symptoms of meningeal
irritation. Ophthalmologic symptoms include visual field defects, visual loss, diplopia,
and ophthalmoplegia. Endocrinologic disturbances include pituitary adenoma symptoms,
cortisol deficiency, panhypopituitarism, diabetes insipidus, and syndrome of inappropriate
secretion of antidiuretic hormone. Magnetic resonance imaging is the imaging method
of choice to aid the PA diagnosis. Its differential diagnoses include cerebrovascular
accidents, infectious diseases, and other causes of endocrinologic imbalance. Transsphenoidal
surgery is the treatment of choice, especially if there are associated visual abnormalities
and ophthalmoplegia. Clinicians should be aware of the presenting symptoms because
early diagnosis may reduce the morbidity and mortality of this neurosurgical emergency.
Keywords
headache - oculomotor palsy - panhypopituitarism - pituitary adenoma - pituitary apoplexy
