Pituitary apoplexy Flashcards
What is pituitary apoplexy?
Acute clinical syndrome caused by either hemorrhagic or non hemorrhagic necrosis of the pituitary gland.
What are the CFx of pituitary apoplexy?
- HA
- Visual deficits
- Opthalmoplegia
- Altered mental status
What is present in 60-90% of cases of pituitary apoplexy?
Pituitary macro adenoma is usually present, but it may occur in healthy glands (few isolated cases)
What are the demographics of pituitary macro adenomas?
Common, prevalence 0.1% but autopsy prevalence ~15%
Factors predisposing to pituitary apoplexy?
- Medical Rx prolactinoma (esp w/ bromocriptine)
- Prior irradiation of the mass
- Pregnancy (Sheehan syndrome)
- Cerebral angiography
- Trauma and surgery
- Anticoagulation
- Changes in ICP
Clinical presentation of pituitary apoplexy?
Due to compression of adjacent structures:
- sudden HA
- loss of visual acuity with chiasmal field defect
- oculomotor palsies
Other
- Dec LOC
- Hypopituitarism
- Addisonian crisis
- SA irritation (2” blood irritation)
General appearance pituitary apoplexy on imaging?
Enlargement of pituitary +/- bleed
- macroscopic haemorrhage (85%): peripheral enhancement around non-enhancing infarcted centre
- surrounding oedema (optic tract and chiasm)
Ddx class reasoning pituitary apoplexy?
Broadly that of pituitary mass but as patients present acutely with blood products, can limit to pituitary region mass with intrinsic high T1 signal
T1 appearance pit apoplexy?
Variable; cases of hemorrhagic infarction are hyper intense due to blood
What are the Ddx for pit apoplexy on imaging?
- Necrotic / haemorrhagic pituitary macroadenoma
- Craniopharyngioma
- Rathke cleft cyst
- Dermoid / teratoma
Fx of necrotic/haemorrhagic macro adenoma?
Fx same but patients do not present acutely therefore not strictly apoplexy
Fx craniopharyngioma?
- Calcification in 90%
- Usually in children
- Usually not acute presentation
What are the Ddx for pituitary adenoma?
- Adult optic neuritis
- Aneurysmal rupture
Imaging in pituitary apoplexy presentation?
- Usu CT first as looks like SAH: will show intrasellar mass with haemorrhagic components
- MRI most sensitive (look for pituitary ring sign)
