Pituitary apoplexy is a rare condition that develops as a result of bleeding into the pituitary gland, and it may also develop if blood circulation to the gland is blocked. The most frequent cause of pituitary apoplexy is bleeding within a benign tumor on the pituitary gland. Larger pituitary tumors increase the risk of pituitary apoplexy. Rarely, patients without pituitary tumors may develop pituitary apoplexy, and risk factors for this situation include diabetes, head injuries, radiation to the pituitary gland, and the use of a breathing machine. To diagnose pituitary apoplexy, patients will need to have an MRI or CT scan, and an eye exam might be performed as well. Several blood tests will be necessary to measure levels of growth hormone, cortisol, adrenocorticotropic hormone, IGF-1, and luteinizing hormone, and urine tests might be done to check for osmolarity.
Cases of acute pituitary apoplexy may be life-threatening, and immediate surgery is normally performed to relieve pressure on the pituitary gland. Patients may also be given immediate treatment with adrenal replacement hormones. In non-urgent or chronic cases of pituitary apoplexy, surgery may be recommended only in instances where the condition is causing vision loss. In addition to adrenal replacement hormones, patients might also need hormone replacement for thyroid hormone, growth hormone, and sex hormones such as testosterone and estrogen. Untreated pituitary apoplexy may lead to vision loss and an adrenal crisis.
Sudden And Severe Headache
Patients with pituitary apoplexy may develop a sudden and severe headache as pressure builds up in the space surrounding the pituitary gland. Many individuals describe this headache as the worst of their lives, and some have described it as a thunderclap. Patients may notice severe pain on one or both sides of their head, and there may be a sharp, throbbing, or stabbing pain in the head that radiates down to the neck.
Emergency medical care is necessary for these types of headaches, and doctors may need to perform CT scans, MRI scans, blood tests, or lumbar punctures to determine the underlying cause of the headache. If scans detect bleeding on the pituitary gland, the patient's care is normally handled by a neurosurgeon. Patients will be given pain relief at the hospital, and the neurosurgeon will discuss next steps, including potential surgery.
Double Vision Or Other Visual Impairments
Pituitary apoplexy can produce double vision or other visual impairments. For example, patients might have difficulty opening their eyelids, and they could also notice a partial or complete loss of peripheral (side) vision. Some individuals have reported total vision loss in one or both eyes. Patients in the emergency room for treatment will be asked about any visual symptoms they may have, and tests will be carried out to evaluate the severity of the vision issues.
Since vision loss can be a symptom of advanced or untreated pituitary apoplexy, doctors will frequently perform emergency surgery to reduce the pressure around the pituitary gland. Patients will have their vision checked after the procedure, and most individuals regain normal vision after treatment.
Nausea And Vomiting
When nausea and vomiting occur with pituitary apoplexy, they are usually an indicator of acute adrenal insufficiency and may be accompanied by loss of appetite and low blood pressure. Also known as an acute adrenal crisis, acute adrenal insufficiency is a life-threatening deficiency in cortisol. Patients who believe their nausea and vomiting are connected to pituitary apoplexy or acute adrenal insufficiency should seek emergency medical care.
Doctors will perform blood tests to determine the underlying cause of the nausea and vomiting, and patients may be given intravenous medicines to reduce these symptoms. Intravenous fluids will be given, and patients will be closely monitored. Individuals experiencing nausea and vomiting should always let their healthcare provider know if the vomit contains blood or if they are experiencing an increase in the number of vomiting episodes.
Pituitary apoplexy can lead to paralysis of the eye muscles, and this paralysis makes it difficult for the patient to open their eyelids. It can also trigger double vision. Paralysis of the eye muscles is generally seen in cases of acute pituitary apoplexy, and it usually resolves once the patient has been treated. Patients who are having sudden trouble with moving their eyes should seek emergency medical care. In the emergency room, doctors may carry out a series of tests to check the patient's eye muscle function.
The patient might be asked to open and close their eyes, and they may also be asked to follow a light with their eyes or to look up or down. To help the medical team, the patient should always let the doctor know if they experience any vision loss in one or both eyes and if they notice any changes in their peripheral vision. Any flashes or floaters in the visual field should be reported too.
Decreased consciousness may develop as acute pituitary apoplexy reaches advanced stages. As consciousness decreases, patients may become confused, and they might have weakness in the face, arms, and legs. A rapid pulse and an irregular heartbeat could occur, and patients might have trouble with balance, which could result in falling. Seizures have been reported, and patients might also lose control of their bladder or bowels. Individuals with reduced levels of consciousness may be very drowsy or difficult to wake, and they could eventually slip into a coma.
Doctors can evaluate a person's level of consciousness using the Glasgow coma scale. The scale assesses eye movement, verbal response, and motor response. Decreased consciousness requires emergency medical care, and patients might need breathing support or other measures. Doctors will perform brain scans to determine the cause of the patient's altered consciousness, and urgent surgery will likely be performed to reduce pressure in the brain that could be causing the patient's symptoms. Patients normally regain consciousness after the pressure has been normalized.