Pituitary Tumor Apoplexy: A Review

This superb review puts in perspective a relatively common problem that presents as a medical emergency and may be difficult to diagnose and to treat appropriately unless it is recognized. This condition, which the authors correctly name pituitary tumor apoplexy, occurs in a small, nonetheless, significant number of patients harboring a pituitary tumor, most often a clinically nonfunctioning macroadenoma. Because these tumors grow very slowly and manifest themselves endocrinologically in a subtle but progressive fashion, the first indication of the presence of the tumor may be a catastrophic ictal event when the tumor abruptly enlarges because of infarction of the tumor and/or hemorrhage into it. 1-6 Patients with pituitary tumor apoplexy may arrive at the emergency room with signs and symptoms that mimic subarachnoid hemorrhage, myocardial infarction, meningitis, stroke, or shock. In addition, to the results of mass effect that include loss of vision, altered consciousness, and severe headache, it is critical to recognize that many such patients will have acute adrenal insufficiency from compression or destruction of the normal pituitary gland. 2-5 The prompt administration of corticosteroids can be a life-saving maneuver, but this may not happen unless pituitary tumor apoplexy is part of the differential diagnosis. Ideally, steroids should be given before the diagnostic studies (computed tomography [CT] or magnetic resonance imaging [MRI] scan) that help to confirm whether the clinical diagnoses are done. In retrospect, many of the patients will have a history compatible with progressive mild