What Causes Pituitary Apoplexy?

Pituitary apoplexy is an emergent medical event where a patient experiences infarction or hemorrhage in their pituitary gland. Symptoms of pituitary apoplexy include altered consciousness, vomiting, headache, facial pain, fever, loss of body and facial hair, infertility, appetite loss, weight loss, weight gain, fatigue, dizziness, seizures, visual defect, altered sensorium, neck stiffness, and endocrine dysfunction. Most symptoms are related to hormonal abnormalities caused by hemorrhage or infarction.

Diagnosis of pituitary apoplexy is made with the use of MRI scans, testing of hormone levels, and vision testing. Treatment of an individual affected by pituitary apoplexy includes the high-dose corticosteroid administered at a rapid rate, diligent monitoring of electrolyte and fluid levels, and emergency transsphenoidal surgery.

Pituitary Adenoma

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A pituitary adenoma is a noncancerous growth or tumor that develops in the pituitary gland. A pituitary adenoma may or may not produce an excessive amount of certain hormones. Although most pituitary adenomas are slow-growing, they can grow to a large size without causing patients to experience noticeable symptoms. A pituitary adenoma can cause pituitary apoplexy through one of two mechanisms. The first mechanism is associated with the damage and bursting of blood vessels in and around the tumor, producing a significant bleed. The blood from this bleed puts too much pressure on the tissues of the pituitary gland, producing the symptoms of pituitary apoplexy.

Another mechanism where a pituitary adenoma can cause a patient to have pituitary apoplexy involves the pituitary adenoma growing large enough to cause the death of a significant amount of tissue in the pituitary gland. This mechanism also produces a significant amount of pressure on and around the functional tissue of the pituitary gland.

Hypertension

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Individuals who have systemic long-term high blood pressure (hypertension) can experience pituitary apoplexy. Hypertension is a condition where the force of the blood against the walls of the blood vessels as it is moving through them becomes too excessive for the blood vessels to handle. Blood vessels are designed to expand with greater blood volume and pressure, but can only do so to a certain degree. Beyond the expansion ability of the blood vessels to cope with increased blood volume and pressure, damage begins to take place in the walls of the blood vessels.

This mechanism can take an immense toll on the smaller blood vessels around the body that weave their way through smaller structures such as the pituitary gland. While the exact mechanism of which high blood pressure causes an individual to experience pituitary apoplexy is not clear, it is thought to involve the damage that occurs in the small blood vessels that provide the pituitary gland with blood. Hypertension causes degenerative alterations in the microvasculature in the pituitary gland tissue, leading to a bleed that causes pituitary apoplexy.

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