Pituitary Apoplexy

What is pituitary apoplexy?

Pituitary apoplexy occurs when there’s a blockage in blood flow or bleeding (hemorrhage) in your pituitary gland. It can be a serious condition, requiring emergency treatment.

What is the pituitary gland?

Your pituitary gland is about the size of a pea and sits at the base of your brain, behind the bridge of your nose. It is one of eight endocrine glands in your body that produce chemical messengers called hormones.

Many of your bodily functions depend on hormones, including:

• Blood pressure regulation.
• Fertility and sexual function.
• Growth and development.

Your pituitary gland releases hormones that signal other endocrine glands to produce their own hormones.

What are pituitary adenomas?

Pituitary apoplexy usually occurs in people who have a benign tumor in their pituitary gland called a pituitary adenoma.

Most people who have a pituitary adenoma don’t know they have it. Healthcare providers often discover the tumor by chance on imaging tests they order for another reason. For some people, pituitary apoplexy is the first sign of pituitary adenoma.

Classification of pituitary adenomas is based on whether they secrete hormones. Some tumors produce too much of certain types of hormones. These hormones may include:

• Adrenocorticotropic hormone (ACTH) stimulates your adrenal gland to produce another hormone called cortisol. Cortisol helps your body respond to stress and fight infections. It also helps regulate your blood pressure, blood sugar and metabolism.
• Prolactin is involved in many bodily functions, but its main role is in breast tissue development and milk production. Elevated levels of prolactin can lead to irregular periods in people assigned female at birth and decreased sex drive in people assigned male at birth.
• Growth hormone controls growth in children and regulates body fat, blood sugar and cell repair in adults.

Nonfunctioning pituitary adenomas don’t secrete hormones. Pituitary apoplexy is more common in nonfunctioning adenomas.

Who does pituitary apoplexy affect?

People assigned male at birth are twice as likely to develop pituitary apoplexy. It’s most common in people between the ages of 37 and 58.

How common is pituitary apoplexy?

Estimates of the frequency of pituitary adenomas vary widely because many people who have them don’t have symptoms. In general, experts believe they’re relatively common. Among people with pituitary adenomas, approximately 2% to 12% develop pituitary apoplexy.

What are the symptoms of pituitary apoplexy?

Symptoms of pituitary apoplexy depend on the extent of the:

• Bleeding.
• Cell death of pituitary gland tissue from the lack of blood flow.
• Swelling (edema).

The most common sign is a sudden and severe headache. More than half of people also have vision problems due to increased pressure on the nerves that run from your brain to your eyes. These may include:

• Double vision.
• Drooping eyelid.
• Partial or full vision loss in one or both eyes.

Some other types of symptoms are caused by changes in your brain. These can resemble other neurological conditions, such as meningitis. These symptoms include:

• Confusion.
• Fatigue.
• Fever.
• Nausea and vomiting.
• Sensitivity to light (photophobia).

Can pituitary apoplexy affect hormonal function?

Damage to your pituitary gland affects the function of other endocrine glands, the hormones they produce and the bodily processes they control.

A common hormonal complication is adrenocorticotropic hormone (ACTH) deficiency. This can affect the function of your adrenal glands and can be life-threatening. Its symptoms include:

• Low blood pressure (hypotension).
• Low blood sugar (hypoglycemia).
• Low sodium levels (hyponatremia).
• Nausea and vomiting.

What causes pituitary apoplexy?

It’s not clear why pituitary apoplexy occurs.

Some studies have found that 10% to 40% of cases are associated with certain types of procedures, health conditions and medications. These include:

• Anticoagulation medications that treat and prevent recurrence of blood clots in people with deep vein thrombosis and pulmonary embolism.
• Dopamine-stimulating medications for treating Parkinson’s disease and restless legs syndrome.
• Endocrine stimulation testing to diagnose endocrine disorders.
• Gonadotropin-releasing hormone (GnRH) treatment to reduce ovarian function, which is important in some people with breast cancer.
• Head trauma, most often from a fall or car accident.
• Surgery, especially orthopedic and cardiac surgery.

Experts are still trying to understand why these factors are sometimes related to pituitary apoplexy. This work will help healthcare providers prevent apoplexy when caring for people with known pituitary adenomas.

How is pituitary apoplexy diagnosed?

Your provider will perform a physical examination to assess your symptoms and order imaging tests.

You may require emergency care, depending on the severity of your condition. In the emergency room, providers use CT scans because they are quick and can help rule out other conditions such as a stroke. If time permits, an MRI is the preferred imaging test. It provides finer detail and helps your provider assess the damage to your pituitary gland.

How is pituitary apoplexy treated?

Treatments for pituitary apoplexy include medications and surgery.

Oral corticosteroids are an essential part of treatment to prevent adrenocorticotropic hormone (ACTH) deficiency. In many cases, people show good improvement with medication.

Your provider may also recommend surgery, especially if your symptoms are getting worse. Usually, this involves a minimally invasive approach to reach your pituitary gland. In this procedure, your provider:

1. Inserts a tube into one of your nostrils.
2. Makes a hole in the bone that separates your nasal cavity from your brain.
3. Inserts a camera through the tube to see the tumor.
4. Removes the tumor or damaged pituitary tissue through the tube.

How can I prevent pituitary apoplexy?

There’s no way to prevent this condition. If you have pituitary adenoma, you should be aware of the possibility of apoplexy. Seek urgent care if you experience a sudden headache or changes in your vision.

What is the outlook for pituitary apoplexy?

Early detection and treatment are critical. This condition is fatal in about 2% of cases.

For most people, visual symptoms improve with medications or surgery. Full recovery of vision occurs about 40% of the time. Approximately 80% of people require long-term hormone replacement therapy. This is because the function of the pituitary gland is decreased. Hormone therapy comes in many forms, including:

• Gels.
• Injections.
• Melts that dissolve in your mouth.
• Nasal sprays.
• Patches.
• Pellets implanted under your skin.
• Pills.

If you have experienced pituitary apoplexy, you’ll likely need follow-up care to:

• Assess your vision.
• Ensure the entire tumor was removed.
• Monitor your hormone levels.

When should I go to the emergency room?

Seek emergency medical care if you experience new vision problems or a sudden headache. Some people describe the headache as the worst of their life.

A note from Cleveland Clinic

Pituitary apoplexy happens suddenly, so it’s important to act fast if you’re experiencing symptoms, such as severe headache and vision changes. The good news is that it is treatable. Treatments are usually very effective at restoring vision. However, many people experience long-term hormonal deficiency. Be sure to attend all your follow-up appointments and follow your provider’s treatment plan. This will help you to best manage your hormone levels and maintain a good quality of life.