Pituitary apoplexy

Question 1

What is it?

Answer 1

Rapid enlargement of pituitary tumour due to infarction or haemorrhage

Question 2

What is it caused by?

Answer 2

Mostly a pituitary adenoma bleeding into pituitary

Question 3

What are the SX?

Answer 3

Acute onset headache
VF loss
Unstable (not secreting cortisol)

Question 4

Give a DDX

Answer 4

Can be mistaken for meningitis

Question 5

What IX must be done?

Answer 5

URGENT!!

Bloods:

• FBC, U&E, LFT, clotting
• Random serum cortisol
• TFTs
• Prolactin
• IGF-1, LH, FSH, testosterone (men), oestradiol (women)

Bedside assessment of VF + visual acuity

MRI - confirm dx

CT if MRI CI
+/- LP to exclude SAH/ meningitis

Question 6

How is it MX?

Answer 6

URGENT!!!

HDU, endocrinologist, surgeon

Steroids life-saving!!

100mg IM hydrocortisone followed by IM 50-100mg 6hrly

OR

100-200mg IV bolus followed by 2-4mg/h continuous IV infusion

Ensure haemodynamic stability
Careful assessment of fluid + electrolyte imbalance

Urgent referral to joint neurosurgical/ endocrine unit for definitive MX

Question 7

What are the indications for empirical steroid therapy?

Answer 7

• Haemodynamic instability
• Altered consciousness
• Reduced VF + visual acuity