Pituitary or pituitary apoplexy is a rare but serious disease. It is a medical emergency that requires appropriate management.

Definition

Pituitary apoplexy is a heart attack or hemorrhage that occurs in a pituitary adenoma (a benign, non-cancerous endocrine tumor that develops from the pituitary gland in the brain). In more than half of the cases, the apoplexy reveals the adenoma which did not give any symptoms.

Causes 

The causes of pituitary apoplexy are not fully understood. Pituitary adenomas are tumors that bleed or die easily. The necrosis could be due to a deficit of vascularization. 

Diagnostic

Emergency imaging (CT or MRI) makes it possible to make the diagnosis by showing an adenoma in the process of necrosis or hemorrhage. Urgent blood samples are also taken. 

The people concerned 

Pituitary apoplexy can occur at any age but is most common in your 3s. Men are slightly more affected than women. Pituitary apoplexy affects 2% of people with a pituitary adenoma. In more than 3/XNUMX of cases, patients do not recognize the existence of their adenoma before the acute complication. 

Risk factors 

People with a pituitary adenoma often have predisposing or precipitating factors: taking certain drugs, invasive examinations, high-risk pathologies (diabetes mellitus, angiographic examinations, coagulation disorders, anti-coagulation, pituitary stimulation test, radiotherapy, pregnancy, treatment with bromocriptine, isorbide, chlorpromazine …)

However, the majority of strokes occur without a precipitating factor.

Pituitary or pituitary apoplexy is a combination of several symptoms, which can appear over hours or days. 

Headaches 

Severe headaches are the initial symptom. Purple headaches are present in more than three quarters of cases. They can be associated with nausea, vomiting, fever, disturbances of consciousness, thus achieving meningeal syndrome. 

Visual disturbances 

In more than half of the cases of pituitary apoplexy, visual disturbances are associated with the headache. These are visual field alterations or loss of visual acuity. The most common is bitemporal hemianopia (loss of the lateral visual field on opposite sides of the visual field). Oculomotor paralysis is also common. 

Endocrine signs 

Pituitary apoplexy is often accompanied by acute pituitary insufficiency (hypopituitarism) which is not always complete.

The management of pituitary apoplexy is multidisciplinary: ophthalmologists, neuroradiologists, neurosurgeons and endocrinologists. 

The treatment of apoplexy is most often medical. Hormonal substitution is implemented to correct the endocrinological deficit: corticosteroid therapy, thyroid hormone therapy. A hydro-electrolytic resuscitation. 

The apoplexy can be the subject of a neurosurgical treatment. This aims to decompress the local structures and particularly the optical pathways. 

Corticosteroid therapy is systematic, whether the aoplexy is treated neurosurgically or monitored without surgery (especially in people with no visual field or visual acuity disorders and no impairment of consciousness). 

When the intervention is rapid, total recoveries are possible, whereas in the event of therapeutic delay there may be permanent blindness or hemianopia. 

In the months following the apoplexy a reassessment of the pituitary function is carried out, in order to see if there are permanent pituitary deficits.

It is not really possible to prevent pituitary apoplexies. However, you should not ignore signs that may be those of a pituitary adenoma, in particular visual disturbances (adenomas can compress the nerves of the eyes). 

Surgical excision of the adenoma prevents another episode of pituitary apoplexy. (1)

(1) Arafah B.M., Taylor H.C., Salazar R., Saadi H., Selman W.R. Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone Am J Med 1989 ; 87 : 103-105