Endocrine Abstracts

Pituitary tumour apoplexy is a condition that occurs as a result of acute haemorrhage and/or infarction within a pituitary tumour (most commonly non-functioning pituitary adenoma), which may or may not be previously known. The clinical presentation occurs within a few hours or days and is due to sudden expansion of the pituitary gland. Manifestations cover a wide range including very intense and frequently retro-orbital headache, nausea and vomiting, visual impairment, ocular paresis, pituitary dysfunction and altered mental state. These, combined with the typical imaging features establish the diagnosis. Management should be prompt and requires involvement of a multidisciplinary team (endocrinologist, neurosurgeon, neuro-ophthalmologist, neuro-radiologist).

Immediate administration of high-dose glucocorticoids should be initiated, even before laboratory results are available, covering not only the increased risk of hypoadrenalism but also offering anti-inflammatory and anti-oedematous effects. Further management strategy will depend on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is offered in cases with severe or progressive deterioration of the visual acuity or visual fields or in the presence of altered mental state, and it leads to visual and neurological recovery in most of the patients. Conservative management and careful monitoring are adopted in cases with mild, stable clinical picture (including those with isolated ocular palsies) resulting in favourable visual and neurological outcomes. If during monitoring progression of symptoms occurs, later surgery is indicated with potential benefit, especially in terms of visual prognosis. Despite the above recommendations, clear proof of optimal outcomes in the form of randomised controlled trials is lacking, and relevant studies are necessary to put the management of pituitary tumour apoplexy on a sounder scientific footing.