Pituitary infarction (pituitary tumour apoplexy)

• What is Pituitary infarction (apoplexy)
• Statistics on Pituitary infarction (apoplexy)
• Risk Factors for Pituitary infarction (apoplexy)
• Progression of Pituitary infarction (apoplexy)
• Symptoms of Pituitary infarction (apoplexy)
• Clinical Examination of Pituitary infarction (apoplexy)
• How is Pituitary infarction (apoplexy) Diagnosed?
• Prognosis of Pituitary infarction (apoplexy)
• How is Pituitary infarction (apoplexy) Treated?
• Pituitary infarction (apoplexy) References

What is Pituitary infarction (apoplexy)

Pituitary infarction or pituitary apoplexy is a disorder of the pituitary gland.

Statistics on Pituitary infarction (apoplexy)

This condition results in an estimated 1.5-27.7% of cases of pituitary adenoma, although the figure is probably closer to 10%.

Risk Factors for Pituitary infarction (apoplexy)

Risk factors for pituitary infarction include diabetes, bleeding disorders, head trauma, pituitary radiation, and use of a breathing machine. However, in most cases, the cause is not clear.

Progression of Pituitary infarction (apoplexy)

Pituitary infarction is most commonly caused by bleeding into a benign tumor of the pituitary, which kills an area of tissue in the pituitary gland. When bleeding occurs during or immediately after childbirth, it is called Sheehan’s syndrome.
Risk factors for pituitary infarction include diabetes, bleeding disorders, head trauma, pituitary radiation, and use of a breathing machine. However, in most cases, the cause is not clear.
Pituitary infarction is usually acute (short period of symptoms) and can be life-threatening.

How is Pituitary infarction (apoplexy) Diagnosed?

Clinical manifestations
Clinical presentation is marked by headache in 95% of cases.
The headache is sudden and postulated to result from stretching and irritation of the dura mater in the walls of the sella supplied by the meningeal branches of cranial nerve V.
The headache also may result from irritation of the trigeminal nerve from the expanding mass.
Frequently, it is retroorbital in location and may be unilateral at onset, then becomes generalized.
Vomiting occurs in 69% of patients and often accompanies the headache.
The mechanism is unclear but may be due to meningeal irritation or increased intracranial pressure.
Visual acuity defects (52%) and visual field defects (64%) result from upward expansion of the tumor, which compresses the optic chiasm, optic tracts, or optic nerve.

Prognosis of Pituitary infarction (apoplexy)

Acute pituitary infarction is a potentially life-threatening event. Prognosis for chronic deficiency (which is detected and treated) is good.

How is Pituitary infarction (apoplexy) Treated?

Treatment for acute infarction may require surgery to decompress the area of the pituitary and improve visual symptoms. Severe cases constitute a surgical emergency. Immediate treatment with adrenal replacement hormones (glucocorticoids) is essential.
Replacement of other missing hormones is also required, including sex hormones (oestrogen/testosterone) and thyroid hormone. Evidence is growing for the need for growth hormone replacement.

Pituitary infarction (apoplexy) References

[1] Kumar, P., Clark, M. Clinical Medicine 5th Ed. 2002 W.B.Saunders.
[2] Michael Vaphiades, Pituitary Apoplexy, University of Alabama
[3] Pituitary infarction as retrieved from www.nlm.nih.gov