Pituitary apoplexy is a rare endocrine emergency, historically confused with other acute medical conditions, which delayed the diagnosis, however with advances in brain imaging, diagnosing this condition is much easier
Acharya Jayashekara & Daniel Flanagan
We describe seven patients with pituitary apoplexy diagnosed between July 2009 and Oct 2010.
Presentation and Management: Five patients presented with sudden onset headache, nausea and vomiting. One developed headache while on carbegoline and other presented with fluctuating level of consciousness.
All but two patients were inpatients at the hospital when diagnosed and all had MRI scan of pituitary to confirm the diagnosis and any mass effects.
All but two patients had visual field assessment. These two patients had cognitive impairment that made this test impossible.
Six patients had baseline pituitary function test. Four patients had insulin stress test to assess dynamic pituitary function.
Two patients underwent trans-sphenoidal hypophysectomy due to the presence of focal neurology (visual field defect and third cranial nerve palsy). Five patients were managed conservatively.
All seven patients were started on hydrocortisone after the diagnosis and two were able to come off hydrocortisone after dynamic testing.
All seven patients are under the follow up of Endocrinologist.
Summary and Conclusion: Our case series shows we are following the UK guidelines for the management of Pituitary apoplexy. MRI scan is very sensitive in diagnosing pituitary apoplexy even when there is low clinical suspicion.