Pituitary Apoplexy

Pituitary apoplexy is a condition in which the pituitary tumor spontaneously hemorrhages (bleeds). The term "pituitary apoplexy" can also describe a less common condition when a pituitary tumor outgrows its blood supply (a stroke).

Pituitary Apoplexy Management in Southern California

The UCLA Pituitary Tumor Program offers comprehensive management of pituitary apoplexy. Our physicians have years of experience in diagnosing, treating and managing pituitary conditions.

Learn more about pituitary apoplexy:

• Physiology
• Pituitary Apoplexy Symptoms
• Diagnosis
• Treatment for Pituitary Apoplexy
• Outcomes
• Contact Us

Pituitary Apoplexy: Physiology

All types of pituitary adenomas can be associated with apoplexy, particularly larger tumors (macroadenomas).

The term apoplexy usually describes larger bleeds leading to the sudden onset of symptoms.

Doctors may suspect pituitary apoplexy because there is a sudden increase in the size of the tumor. This sudden increase may compress the:

• 
  Normal pituitary gland
• Optic nerves
• Nerves that control eye movements

Pituitary apoplexy is rarely life threatening, if you receive prompt and accurate diagnosis and treatment.

The compression may also lead to a loss of blood supply (pituitary infarct), which can cause tumor cell death, bleeding and sudden tumor swelling.

It is difficult to predict who will develop pituitary apoplexy, although it has been associated with a wide range of disorders and treatment side effects. In many cases, doctors see small hemorrhages into a pituitary tumor on magnetic resonance imaging (MRI) scan, which were not associated with an "apoplectic" event.

Pituitary Apoplexy: Symptoms

Symptoms of pituitary apoplexy vary, but may include:

Visual Loss

• 
  Sudden onset of headache and/or nausea; if the bleeding extends into the cerebrospinal fluid spaces, severe headache, neck stiffness and fever may occur.
• Vision loss
  • Sudden visual loss (or worsening of vision) can occur if the optic chiasm becomes (more) compressed.
  • A loss of the outer peripheral vision (called a "bitemporal hemianopsia") or complete blindness can occur.
  • Double vision; lateral expansion into the cavernous sinuses can compress the nerves controlling eye movement, leading to double vision.

Pituitary Failure or Hypopituitarism

Increased compression of the normal gland can cause hormone insufficiency, called hypopituitarism. The symptoms depend upon which hormone is involved.

• Reduction of sex hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
  • In men, this can lead to a low testosterone level, causing decreased sexual drive and impotence.
  • In some cases, there can be loss of body and facial hair.
  • In women, this can lead to infertility.
• Large pituitary tumors can slightly elevate blood prolactin levels. Doctors think this occurs because of compression of the pituitary stalk, the connection between the brain and pituitary gland. It is called the "stalk effect."
  • In premenopausal women, this can lead to reduction or loss of menstrual periods and/or breast milk production (galactorrhea).
  • Prolactin levels are only slightly elevated, as opposed to prolactinomas in which the prolactin level is usually very high.

More severe hypopituitarism can lead to hypothyroidism or abnormally low cortisol levels, which may be life threatening. Symptoms of severe hypopituitarism include:

• Loss of appetite
• Weight loss or weight gain
• Fatigue
• Decreased energy
• Decreased mental function
• Dizziness

Changes in hormonal function can cause electrolyte imbalance in the blood, typically low sodium levels (hyponatremia). Symptoms could include:

• Fatigue
• Seizures

Pituitary Apoplexy: Diagnosis

Your doctor will conduct a thorough physical exam and ask you about your symptoms and medical history. Other diagnostic procedures include:

• 
  Magnetic resonance imaging (MRI)
• Hormone testing
• Visual testing

MRI Imaging

One method doctors use to diagnose pituitary apoplexy is using MRI scans. At the UCLA Pituitary Tumor Program, we use a special MRI pituitary protocol in order to best visualize the tumor. Our specialists examine the scan together to determine the size of the bleed.

You may also undergo a computerized tomography (CT) scan of the pituitary gland, which will also show if there is an abnormality.

Hormone Testing for Pituitary Apoplexy

If your symptoms suggest pituitary failure (hypopituitarism), you need a complete evaluation of the endocrine system.
Based on results of these blood tests, your doctor may order additional hormonal studies.

Learn more about hormone testing at the UCLA Pituitary Tumor Program.

Visual Testing

If you suffer from visual symptoms, then an experienced ophthalmologist should evaluate you. This evaluation should include:

• Acuity testing of each eye
• Formal visual field testing to determine if there is loss of peripheral vision

Pituitary Apoplexy: Treatment Options

After diagnosis, you will begin your course of treatment. Treatment options for pituitary apoplexy include:

• Rapid administration of high-dose corticosteroid
• Careful monitoring of fluid and electrolyte levels
• Urgent transsphenoidal surgery

If the pituitary adenomas require surgery, typically the best procedure is through a nasal approach. Our neurosurgeons who specialize in pituitary tumor surgery are experts in the minimally invasive endoscopic endonasal technique. This procedure removes the tumor while minimizing complications, hospital time and discomfort. This advanced technique requires specialized training and equipment.

No matter what course of treatment you undergo, one of our experienced endocrinologists will monitor you carefully during treatment and recovery.

Pituitary Apoplexy: Outcome

Most patients have significant visual improvement after surgery; however, a majority will have permanent hormone deficiencies due to pituitary injury. You may require hormone replacement therapy for life.

Contact Us

To schedule an appointment with one of our physicians at the Pituitary Tumor Program, please call (310) 825 5111.