Pituitary apoplexy

Pituitary apoplexy (PA) is a clinical syndrome caused by acute haemorrhage and/or infarction of the pituitary gland, generally within a frequently undiagnosed pituitary adenoma. The sudden increase in pituitary gland volume is responsible for typical symptoms: severe headache, nausea, vomiting, visual impairment, cranial nerve palsies, deteriorating level of consciousness, and hypopituitarism. Radiological evidence, especially magnetic resonance imaging (MRI) which is the most sensitive diagnostic modality, establishes the diagnosis. Multiple risk factors have been reported, although the majority of cases have no identifiable precipitants. The management strategy depends on the clinical manifestation, as well as the presence of co-morbidities, and remains controversial. Post apoplexy, there needs to be careful monitoring for recurrence of tumour growth and endocrinological function of the pituitary. This disease is rare but potentially life-threatening without rapid treatment. Because there are no randomised studies, it is suggested that further trials are needed to optimise proper management.