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Pituitary Apoplexy

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Abstract

Pituitary apoplexy is an acute clinical syndrome that occurs from the spontaneous hemorrhage and/or infarction of a pre-existing pituitary adenoma. Pituitary apoplexy arises most frequently in undiagnosed pituitary adenomas and is associated with worse outcomes than pituitary adenomas detected without acute clinical deterioration. The pathophysiology of pituitary apoplexy is not completely understood; however, it is thought to occur due to rapid tumor growth outstripping the blood supply, impingement of local blood vessels, and/or structurally and functionally abnormal intratumoral blood vessels that might be prone to hemorrhage. A variety of precipitating factors are associated with pituitary apoplexy including acute increases in blood flow, coagulative disturbances, pregnancy, and head trauma. Classic clinical symptoms of pituitary apoplexy include acute-onset headache, visual changes, cranial nerve palsy, and endocrine dysfunction; however, its clinical presentation and outcome are variable. Pituitary apoplexy is commonly managed surgically, although in certain cases when patients have mild symptomatology and comorbidities increasing the risk of surgery, conservative nonsurgical management with reabsorption of infarcted tissue over time can be considered. This chapter will outline the epidemiology, pathophysiology, risk factors, and management of pituitary apoplexy.

Patrick M. Flanigan and Arman Jahangiri contributed equally to this work.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Patrick M. Flanigan BS

  2. University of California at San Francisco, Neurological Surgery, San Francisco, CA, USA

    Arman Jahangiri BS, Han S. Lee MD, PhD & Manish K. Aghi MD, PhD

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  1. Patrick M. Flanigan BS
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  2. Arman Jahangiri BS
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  3. Han S. Lee MD, PhD
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  4. Manish K. Aghi MD, PhD
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Correspondence to Manish K. Aghi MD, PhD .

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Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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Flanigan, P.M., Jahangiri, A., Lee, H.S., Aghi, M.K. (2017). Pituitary Apoplexy. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_29

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