Diagnosis and Management of Pituitary Apoplexy in Adult Patients

Abstract

Pituitary apoplexy is a rare medical emergency in patients with pituitary tumours. Patients may present at emergency departments or at different medical services and this can lead to diagnostic difficulties and delays. Pituitary apoplexy is caused by a rapid increase in the size of the intrasellar contents leading to increase in the intrasellar pressure. This increased pressure may lead to loss of blood supply to the pituitary gland causing infarction, tumour cell death, bleeding, and tumour swelling. Patient can present with sudden onset of headache, vomiting, visual impairment, and decreased consciousness. Assessment of suspected pituitary apoplexy includes a mixture of clinical, endocrine, and radiological assessments. Clinical management includes immediate steroid therapy followed by the decision to manage conservatively or surgically. The long-term follow-up includes endocrine and visual assessment and imaging surveillance. The endocrine specialist nurse has an important role in acute management of the patient with apoplexy including performing endocrine testing, steroid replacement therapy education and long term monitoring and outcome measurement.