Pituitary apoplexy is a rare, but serious condition of the pituitary gland.
Pituitary infarction; Pituitary tumor apoplexy
The pituitary is a small gland at the base of the brain. The pituitary produces many of the hormones that control essential body processes.
Pituitary apoplexy can be caused by bleeding into the pituitary or by blocked blood flow to the pituitary. Apoplexy means bleeding into an organ or loss of blood flow to an organ.
Pituitary apoplexy is commonly caused by bleeding inside a noncancerous (benign) tumor of the pituitary. These tumors are very common and are often not diagnosed. The pituitary is damaged when the tumor suddenly enlarges. It either bleeds into the pituitary or blocks blood supply to the pituitary. The larger the tumor, the higher the risk for future pituitary apoplexy.
When pituitary bleeding occurs in a woman during or right after childbirth, it is called Sheehan syndrome. This is a very rare condition.
Risk factors for pituitary apoplexy in non-pregnant people without a tumor include:
Pituitary apoplexy in these situations is very rare.
Pituitary apoplexy usually has a short period of symptoms (acute), which can be life threatening. Symptoms often include:
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:
In rare cases, when the posterior (back part) of the pituitary is involved, symptoms may include:
Acute apoplexy may require surgery to relieve pressure on the pituitary and improve vision symptoms. Severe cases need emergency surgery. If vision is not affected, surgery is often not necessary.
Immediate treatment with adrenal replacement hormones (glucocorticoids) may be needed. These hormones are often given through the vein (by IV). Other hormones may eventually be replaced, including:
Acute pituitary apoplexy can be life threatening. The outlook is good for people who have long-term (chronic) pituitary deficiency that is diagnosed and treated.
Complications of untreated pituitary apoplexy can include:
If other missing hormones are not replaced, symptoms of hypothyroidism and hypogonadism may develop, including infertility.
Call your 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 apoplexy, including:
If you develop these symptoms and you have already been diagnosed with a pituitary tumor, seek medical help right away.
Hannoush ZC, Weiss RE. Pituitary apoplexy. In: Feingold KR, Anawalt B, Boyce A, et al, eds. Endotext [Internet]. South Dartmouth, MA: MDText.com. 2000-. www.ncbi.nlm.nih.gov/books/NBK279125. Updated April 22, 2018. Accessed May 20, 2019.
Melmed S, Kleinberg D. Pituitary masses and tumors. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 9.