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Pituitary apoplexy

Pituitary infarction Endocrine glands Definition: Pituitary infarction is the death of an area of tissue in the pituitary gland, a small gland joined to the hypothalamus (part of the brain). The pituitary produces many of the hormones that control essential body processes. Alternative Names: Pituitary apoplexy Causes, incidence, and risk factors: Pituitary infarction is most commonly caused by bleeding due to a non-cancerous tumor of the pituitary. When this bleeding occurs in a woman during or immediately after childbirth, it is called Sheehan syndrome. Risk factors for pituitary infarction include: Bleeding disorders Diabetes Head injury Radiation to the pituitary gland Use of a breathing machine However, in most cases, the cause is not clear. Symptoms: Pituitary infarction usually has a short period of symptoms (acute), but it can be life-threatening. Symptoms usually include: Severe headache Paralysis of the eye muscles causing double vision (ophthalmoplegia) Low blood pressure, nausea, and vomiting from acute adrenal insufficiency Less commonly, pituitary dysfunction may appear more slowly. In Sheehan syndrome, for example, the first symptom may be a failure to produce milk caused by a lack of the hormone prolactin. Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions: Growth hormone deficiency Fatigue Increased fat in the abdomen Lack of energy Loss of bone and muscle Problems with fat metabolism (dyslipidemia) Hypoadrenalism (if not already present or treated) Inability to deal with physical stress Low blood pressure Nausea Hypogonadism Absent periods (amenorrhea) in women Sexual dysfunction and loss of muscle mass in men Hypothyroidism Cold intolerance Dry skin Hoarseness Mental slowing Weight gain When the posterior pituitary is involved (rare), symptoms may include: Failure of the uterus to contract as needed to give birth to a baby (in women) Failure to produce breast milk (in women) Uncontrolled urination Signs and tests: Signs of acute pituitary infarction may include: Low blood pressure Visual field defects Signs of chronic pituitary insufficiency include: Growth hormone deficiency Loss of muscle mass Hypoadrenalism Low blood pressure Poor response to stress and infection Hypothyroidism Delayed reflexes Tests may include: Bone density test Eye exams MRI or CT scan Blood tests will be done to check levels of: ACTH Cholesterol Cortisol FSH Growth hormone LH Prolactin Somatomedin C (IGF-1) Treatment: Treatment for acute infarction may require surgery to relieve pressure on the pituitary and improve vision symptoms. Severe cases need emergency surgery. Immediate treatment with adrenal replacement hormones (glucocorticoids) is essential. Other hormones will be replaced, including: Sex hormones (estrogen/testosterone) Thyroid hormone Evidence is also growing for the need to replace growth hormone. Expectations (prognosis): Acute pituitary infarction can be life-threatening. The outlook is good for people who have chronic deficiency that is diagnosed and treated. Complications: Complications of untreated pituitary infarction can include: Adrenal crisis Vision loss If other missing hormones are not replaced, you may develop problems related to hypothyroidism and hypogonadism. Calling your health care provider: Call your health care provider if you have any symptoms of chronic pituitary insufficiency. Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of acute pituitary infarction, including: Eye weakness Headache Low blood pressure (which can cause fainting) Nausea Vomiting Be especially concerned if you develop these symptoms and you have already been diagnosed with a pituitary tumor. References: Melmed S, Kleinberg D. Anterior Pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 8.

Review Date:3/18/2008 Reviewed By:Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.