Pituitary Apoplexy - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

The pituitary gland, a pea-sized gland located in the skull base, also called the "master gland," controls the functions of different body parts by secreting many hormones. In addition, the hypothalamus and the pituitary gland work together to produce and release various hormones that act on other body parts.

What Are the Other Names of Pituitary Apoplexy?

The other names of the condition include

• Pituitary tumor apoplexy.

• Pituitary infarction.

What Is the Cause of Pituitary Apoplexy?

Pituitary apoplexy is a rare condition that affects the pituitary gland. Apoplexy refers to bleeding into an organ or cut-off of blood supply to an organ, causing symptoms of a sudden stroke. Pituitary apoplexy commonly occurs due to benign (harmless) pituitary gland tumors that grow big, causing pressure and bleeding into the gland. Sometimes, there is also a loss of blood supply to the gland due to the formation of a blood clot, causing pituitary apoplexy. Though pituitary tumors are small and without symptoms that go unnoticed, when they cause apoplexy, severe symptoms occur, which require immediate medical attention. In addition, the bigger the size of the tumors, the greater the risk of developing pituitary apoplexy.

What Are the Risk Factors for Developing Pituitary Apoplexy?

Pituitary apoplexy can also develop in people without tumors. The risk factors for developing the condition in such people include

1. Diabetes.

2. Bleeding disorders.

3. Injuries to the head.

4. Radiation to the brain or pituitary gland.

5. Use of a breathing machine for lungs.

However, the chances of developing pituitary apoplexy are rare in the above conditions.

How Is Pituitary Apoplexy Related to Sheehan’s Syndrome?

Sheehan's syndrome is when pituitary bleeding occurs in women during or immediately after delivery.

What Are the Symptoms of Pituitary Apoplexy?

Pituitary apoplexy has symptoms that are very serious and require appropriate treatment immediately. However, they are called acute and present only for a short period before turning severe and life-threatening.

The various symptoms that occur include

• Severe headaches can be the worst ones experienced in the whole lifetime.

• Paralysis of the eye muscles causes difficulty opening the eyelids or double vision.

• Vision loss in one or both eyes.

• An adrenal crisis occurs due to damage to the pituitary gland causing symptoms like low blood pressure, nausea and vomiting, and appetite loss.

• Personality changes occur due to the sudden narrowing of the brain arteries.

Symptoms in conditions like Sheehan's syndrome occur more slowly; the early sign is an inability to produce breast milk after delivery due to the lack of hormone prolactin produced by the pituitary gland. As the amount of pituitary gland hormones released also gets affected, symptoms of the following can occur due to the imbalance, which includes:

• Adrenal Insufficiency: A disorder in which the adrenal glands do not produce sufficient amounts of the hormone cortisol.

• Growth Hormone Deficiency: A condition in which there is insufficient growth hormone production, causing stunted growth in children.

• Hypothyroidism: A condition that causes a decreased production of thyroid hormone.

• Hypogonadism: A condition where gonads do not function properly, causing reduced or no sex hormone production.

Sometimes, the back part (posterior) of the pituitary gland may be involved, which leads to symptoms like:

• Excessive urination and increased thirst.

• Failure of the uterus to contract and give birth to a baby.

• An inability of new mothers to produce breast milk.

What Are the Complications of Pituitary Apoplexy?

Untreated cases of pituitary apoplexy can cause severe complications like:

1. Loss of vision.

2. Infertility.

3. Adrenal crisis, a life-threatening condition that occurs due to a severe shortage of the hormone cortisol released by the adrenal glands. It causes confusion, dizziness, fatigue, headache, weakness, and coma symptoms.

How Is Pituitary Apoplexy Diagnosed?

Doctors note down medical history and conduct a thorough physical examination. Then, they may recommend specific tests to confirm the diagnosis, which include

Blood tests: Blood tests are recommended to check for the levels of the following, which include

1. ACTH (adrenocorticotropic hormone).

2. Cortisol.

3. Growth hormone (GH).

4. Follicle-stimulating hormone (FSH).

5. Luteinizing hormone (LH).

6. Prolactin.

7. Thyroid-stimulating hormone (TSH).

8. Insulin-like growth factor 1 (IGF-1).

9. Sodium.

10. Blood and urine osmolarity.

Imaging Tests: Imaging tests like CT (computerized tomography) scans and MRI (magnetic resonance imaging) help view the pituitary tumor and the location and size of the bleed. CT scan creates cross-sectional images using X-rays and computer processing, whereas MRI uses magnetic and radio waves to get fine details about the internal organs.

Visual Tests: Visual tests are advised for patients who experience problems with vision. The evaluation includes

1. Acuity testing determines how well a person can see the details of numbers or alphabets from a specific distance. Acuity testing is done for both eyes.

2. Formal visual field testing helps assess the ability of a person to perceive light coming from different fields or areas.

How Is Pituitary Apoplexy Treated?

The immediate treatment options for cases of pituitary apoplexy include

• Administration of high-dose corticosteroids.

• A check on the fluid and electrolyte imbalance.

• Urgent surgery in severe cases.

Surgery helps relieve pressure on the pituitary gland and improves vision. An endoscopic endonasal technique is employed for surgery, in which the tumor is approached from the nose (nasal approach), which causes less discomfort and complications. Surgery may not be necessary in cases where the vision is unaffected. An immediate administration of adrenal replacement hormones like glucocorticoids through the IV (intravenous) route helps reverse the symptoms of an adrenal crisis. Other hormones that need to be gradually replaced include:

• Growth hormone.

• Thyroid hormone.

• Sex hormones like estrogen and testosterone.

• Vasopressin or Antidiuretic hormone (ADH).

When to Call a Doctor?

A doctor has to be contacted immediately in case of the below symptoms and when the patient already has a pituitary tumor. The symptoms include:

• Weakness of eye muscles.

• Vision loss.

• Sudden and severe headache.

• Nausea and vomiting.

• Low blood pressure leads to fainting.

When experiencing the above symptoms, seeking medical care right away is pivotal.

Conclusion:

Pituitary apoplexy is an emergency condition requiring immediate treatment to prevent vision loss and adrenal crisis. Many patients have improved vision post-surgery; however, many can experience hormonal deficiencies requiring hormone replacement therapy. Also, a visit to their endocrinologist is necessary to check their hormonal levels.