Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 25, 2009
Pituitary Apoplexy
- Pituitary apoplexy is characterized by headache, visual loss, meningism, ophthalmoplegia, vomiting, hormonal dysfunction, and altered mental status caused by sudden hemorrhage or infarction of the gland.
- It is more common in patients with previously undiagnosed pituitary adenomas or, less commonly, in a nonadenomatous gland having been described in association with therapeutic anticoagulation and thrombocytopenia.
- The anterior pituitary gland is perfused by its portal venous system, which passes down the hypophyseal stalk. This unusual vascular supply likely contributes to frequency of pituitary apoplexy.
- This is a rare, life threatening neurological emergency. Pituitary apoplexy can cause devastating and instantaneous effects on previously normal pituitary function. Immediate administration of corticosteroids is mandatory due to the high incidence (2/3 of patients) demonstrating acute adrenal insufficiency.
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