Overview Of Options To Treat Pituitary Apoplexy

November 2, 2023

The pituitary gland is situated at the brain's base. It sends out chemical messengers telling other organs what to do. This includes the thyroid and adrenal glands. Pituitary apoplexy, a rare medical emergency, is typically the result of a tumor in the pituitary gland. The tumors that cause it have usually triggered either the death of part of the gland or caused it to bleed profusely. This condition can also occur right after childbirth. When it does, it is called Sheehan's syndrome. Symptoms include nausea, vomiting, paralysis involving eye movements, double vision, and a sudden, severe headache.

Patients need prompt treatment for pituitary apoplexy. Many individuals will undergo surgical decompression for pituitary apoplexy. There are also several medications for pituitary apoplexy that are available. However, the best pituitary apoplexy treatment can vary between patients, which is why understanding all of the options is essential.

Cortisol Replacement Therapy

The adrenal glands, which are located just above the kidneys, produce cortisol. Cortisol is a critical hormone involved in many of the body's functions. It is necessary for life and also helps the body cope with stress. The pituitary gland controls the adrenal glands by sending out a chemical signal called ACTH. Suppose this condition damages the pituitary gland. In that case, it can no longer send signals to the adrenal glands to release cortisol. Insufficient cortisol can result in symptoms like fainting from low blood pressure, craving for salt, skin darkening, and feeling fatigued.

Cortisol replacement therapy means that certain drugs are used to replace the cortisol that the adrenal glands are not producing. Examples of medications used are hydrocortisone and prednisone. These drugs have similar actions to cortisol. Hydrocortisone is the same ingredient in some over-the-counter itch creams. However, when used in this type of therapy, it is generally taken orally. Some patients may receive it intravenously as a continuous infusion.

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Surgical Decompression

Surgical decompression for pituitary apoplexy is performed to stop bleeding and relieve pressure on the pituitary gland. This gland is accessed through the nose, not the skull. The severity of symptoms determines the need for this surgery. More conservative methods may treat milder symptoms. However, if significant visual impairment or low consciousness levels are present, surgery may be necessary.

The patient is monitored closely after surgery to be sure that the pituitary gland's function is intact. If it is not, hormone replacement therapy is given until normal function returns. Some patients may develop a condition called diabetes insipidus immediately after this type of surgery. This disease is unrelated to type 2 diabetes. It means that the kidneys cannot regulate the body's fluid levels properly. Typically, it is temporary, and normal kidney function resumes after the recovery period.

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Dopamine Agonists

Dopamine is a critical neurotransmitter that is involved in normal body movement. Neurotransmitters are chemical messengers that brain cells use to communicate with each other. A dopamine agonist refers to medications that imitate the actions of the natural dopamine that the brain produces. Two examples are cabergoline and bromocriptine. This type of medication can be used to treat some instances of pituitary apoplexy. Specifically, these medications help treat cases caused by prolactinoma. This is a benign tumor. It causes the pituitary gland to overproduce a hormone called prolactin. Symptoms include milky breast discharge, acne, and excessive body and facial hair.

However, this type of medication is also a known risk factor for the development of pituitary apoplexy. Thus, doctors must monitor patients on this medication closely.

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Gamma Knife Radiation Therapy

Although surgical decompression is the first-line treatment for severe pituitary apoplexy, it is not always successful. Thus, patients will often undergo gamma knife radiation therapy. This is a type of highly-focused radiation therapy that is particularly suited for brain tumors less than one inch in diameter. It often helps treat pituitary apoplexy when other treatments leave some of the tumor behind. Patients treated with gamma knife radiation therapy respond favorably in about fifty to ninety percent of cases, depending upon each patient and tumor factors. Although generally regarded as safe, this treatment has side effects. These side effects include seizures, brain edema, necrosis, and hemorrhage.

The beam of radiation used in this treatment is so precise that surrounding tissues are not affected. Extensive imaging techniques are used before gamma knife radiation therapy. Before the procedure, a steel halo device is fitted to the patient's head to ensure the exact delivery of the radiation beam. This treatment aims to reduce or destroy the tumor without compromising pituitary gland function or vision.

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Long-Term Patient Monitoring

Pituitary apoplexy is treatable. Many patients recover the full function of their pituitary gland. However, they will need careful follow-up care for an extended period after the initial successful recovery. This is because tumors can recur and cause this condition again. Long-term patient monitoring is part of the overall treatment for pituitary apoplexy. An endocrinologist is the best type of doctor for this kind of monitoring. The reason for this is because they have received special training in the function of the body's glandular system.

Many patients with this condition will require hormone replacement therapy for life. These hormones must be precisely balanced. This requires regular blood tests. Blood tests are necessary to check for normal pituitary function and hormone levels. Patients should also receive regular MRI scans to check for possible tumor regrowth. As long as patients receive the proper long-term care, the prognosis for pituitary apoplexy is generally quite good.

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