Pituitary apoplexy refers to the onset of acute symptoms following hemorrhage and/or infarction of the pituitary gland. Hypopituitarism may follow if the extent of destruction exceeds the glandular reserves.


Predisposing condition - Some form of pituitary disorder is usually present:

(1) pituitary adenoma

(2) hyperplasia (pregnancy, etc.)


Causes of the acute hemorrhage or infarction:

(1) anticoagulation therapy

(2) head trauma

(3) radiation therapy

(4) therapy with bromocriptine

(5) dynamic pituitary function tests (with TRH or gonadotropin releasing hormone)

(6) expanding lesion adjacent to the pituitary gland

(7) diabetes mellitus

(8) hypotension (post-partum, post-operative, post-hemorrhagic, etc.)

(9) hypo- or hypercoagulability, including DIC

(10) carotid angiography

(11) increased intracranial pressure

(12) surgery for a pituitary tumor

(13) massive stroke

(14) snakebite (Burmese Russell viper)

(15) sickle cell disease

(16) metastatic neoplasm



• Sheehan syndrome (previous section) is post-partum pituitary apoplexy.


Clinical findings:

(1) compression of the optic nerve and/or chiasm can result in visual field defects

(2) compression of cranial nerves III, IV and/or VI can result in ophthalmoplegia, diplopia, ptosis, mydriasis

(3) compression of the cranial nerve V branches can result in impaired corneal reflex and reduced sensation on one or both sides of the face

(4) CSF rhinorrhea or epistaxis

(5) hypopituitarism with multiple endocrine abnormalities

(6) acute onset or worsening of headache

(7) seizures


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