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J Neurol Surg A Cent Eur Neurosurg 2018; 79(01): 052-059
DOI: 10.1055/s-0037-1599051
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Presenting Symptoms of Pituitary Apoplexy

Efstratios-Stylianos Pyrgelis
1   Department of Internal Medicine, K.A.T. General Hospital of Attica, Athens, Greece
,
Ioannis Mavridis
2   Department of Neurosurgery, K.A.T. General Hospital of Attica, Athens, Greece
,
Maria Meliou
3   Department of Internal Medicine, Sotiria General Hospital of Chest Diseases, Athens, Greece
› Author Affiliations
Further Information

Publication History

04 August 2016

20 December 2016

Publication Date:
24 April 2017 (online)

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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