What is Pituitary Apoplexy?

It is a sudden hemorrhage (bleeding) or infarction (loss of blood supply) into a pituitary tumor. It is a medical emergency.

Who is at risk?

People with an existing pituitary adenoma (often previously undiagnosed). Triggers can include anticoagulation, head trauma, or pregnancy.

Symptoms (Sudden Onset):

• Thunderclap Headache: Severe, sudden headache ("worst headache of my life").
• Vision Loss: Due to swelling compressing the optic nerves. Can be irreversible if not treated urgently.
• Double Vision (cranial nerve palsies).
• Nausea, Vomiting, Altered Mental Status.
• Adrenal Crisis: The bleeding destroys the pituitary, causing sudden cortisol deficiency → collapse, shock.

Diagnosis:

• MRI or CT: Shows bleeding into the pituitary.
• Hormone Levels: Check cortisol (often very low).

Treatment:

• IV Hydrocortisone (Stress Dose Steroids): IMMEDIATELY, before any other intervention.
• Neurosurgery Consult: Urgent decompression surgery may be needed if vision is threatened.
• Supportive Care: IV fluids, monitoring.

Outcome:

With prompt treatment, most patients survive. However, permanent hormone deficiencies (requiring lifelong replacement) and vision loss can occur.