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Indications for Conservative Management in a Patient with Acute Pituitary Apoplexy

Description

Some patients presenting with pituitary apoplexy can be managed conservatively. Mild findings may improve spontaneously but the patient must be routinely monitored for findings that more aggressive management is needed. The authors are from the Pituitary Apoplexy Guideline Development Group in the UK.


 

Patient selection: acute pituitary apoplexy

 

Conservative management is indicated if all of the following are (normal) OR (mild AND stable):

(1) visual acuity

(2) visual fields

(3) level of consciousness

 

A patient being managed conservatively needs to be periodically monitored for signs of deterioration.

 

State

Clinical Evaluation

reduced visual acuity or defective visual fields

every day until clear trend of improvement

acutely unwell

every hour, then every 4-6 hours once stable

 

The patient should be monitored for evidence of over- or under-secretion of pituitary hormones with daily monitoring of renal function and serum electrolytes.

 

Surgery should be considered if the neuro-ophthalmic signs

(1) fail to improve

(2) deteriorate

 


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Specialty

ICD-10