Guijt et al reported a classification of pituitary apoplexy based on its presentation and time course. The authors are from Leiden University in The Netherlands.

Patient selection: pituitary apoplexy


Pituitary-related symptoms in pituitary apoplexy:

(1) headache

(2) visual field defects

(3) decrease in visual acuity

(4) ophthalmoplegia





acute (< 3 days)

clear and sudden; headaches severe


subacute (3 to 21 days)

acute and less acute


non-acute (> 2 weeks)

not obvious or sudden; delayed onset of headache



The authors also recognized Type D, for a pituitary adenoma without apoplexy. This patient would be at risk for future apoplexy.


Hypopituitarism is manifested by combinations of hypocorticolism, hypothyroidism, hypogonadism, hyposomatotropism, hyperprolactinemia and diabetes insipidus.


Type A patients are seen soon after onset in the Emergency Department and 75% are seen early by neurologists.


Type C patients are usually seen by a primary care provider with only a quarter initially referred to neurology.

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