Pituitary apoplexy: diagnosis and management

Journal ArticlePituitary apoplexy, an uncommon complication of pituitary adenomas, was first decribed in 1898 when pearce Bailey reported hemorrhage into a pituitary adenoma in a 50 year old man with acromegaly. The patient presented with sudden onset of headache, nausea, vomiting, fever, oculomotor palsies, and visual loss. Postmortem examination revealed hemorrhage in the intrasellar adenoma and endarteritis of the adernohypophyseal vasculature. A similar case was reported in 1905 of a 21 year old man with acromegaly who presented with acute hemorrhage and necrosis in to a pituitary adenoma. This clinical entity remained somewhat obscure until 1950, when brougham and co-workess reported postmortem findings of acute degenerative changes in pituitary adenmas in five cases. They described a clinicopathological syndrome characterized by an abrupt onset of headache ophthalmoptegia, blindness, stupor, or coma, and named in pituitary apoplexy. It is postulated that this condition is caused by sudden expansion of a pituitary adenoma secondary to hemorrhage into or infarction of the tumor mass, which leads to compression of local supreasellar and parasellar struchires. Various definitions have been proposed for pituitary apoplexy