Pituitary apoplexy new society guidelines for treatment
John Wass, Senthil Kumar, Narendra Reddy, Mark Vanderpump & Stephanie Baldeweg
The guidelines for the treatment of pituitary apoplexy have now been published in Clinical Endocrinology (Clin Endocrinol 2011 Jan;74(1):920). These resulted from a group set up during the London pituitary multidisciplinary meeting.
Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving. It is a clinical syndrome characterised by the sudden onset of headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage and/or infarction of the pituitary gland. It is associated with the sudden onset of headache accompanied or not by neurological symptoms involving the second, third, fourth and sixth cranial nerves. If diagnosed patients should be referred to a multidisciplinary team comprising, amongst others, of a neurosurgeon and an endocrinologist. Apart from patients with worsening neurological symptoms in whom surgery is indicated it is unclear currently for the majority of patients whether conservative or surgical management carries the best outcome.
Post apoplexy: There needs to be careful monitoring for recurrence of tumour growth. It is suggested that further trials be carried out into the management of pituitary apoplexy in order to optimise treatment.