Pituitary apoplexy

Pituitary apoplexy results from haemorrhage or infarction of the pituitary in 1-10% of patients with pituitary adenomas (1).

Pituitary apoplexy has very rarely been described during pregnancy, when it is potentially life-threatening to both the mother and the fetus (2).

It is characterised by:

• severe headache of acute onset, similar to that in subarachnoid haemorrhage
• neck stiffness may be present
• rapidly progressive visual impairment
• extraocular nerve palsies
• primary pituitary insufficiency
• stupor and then coma
  
  

Steroid cover - iv. hydrocortisone, attention to fluid balance, and early transphenoidal surgery are necessary.

Survivors require lifelong replacement therapy for the resultant hypopituitarism.

Reference:

• Kuvera . Pituitary Tumours. Med. Int 1993;21:5
• Piantanida E et al. Pituitary apoplexy during pregnancy: a rare, but dangerous headache.J Endocrinol Invest. 2014