Pituitary apoplexy - Revision history

Danbot: Add MedicationDose entry for hydrocortisone

2026-03-20T21:10:58Z

Add MedicationDose entry for hydrocortisone

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 ==Disposition==
 *Admit to floors vs ICU
 ==See Also==

Rossdonaldson1: /* Differential Diagnosis */

2024-02-14T16:24:24Z

Differential Diagnosis

← Older revision		Revision as of 16:24, 14 February 2024
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	==Differential Diagnosis==		==Differential Diagnosis==
	*[[Adrenal crisis]]		{{Adrenal crisis ddx}}
	*[[Sepsis]]
	*[[Sheehan's syndrome]]
	{{Headache DDX}}		{{Headache DDX}}

Rossdonaldson1: /* Background */

2024-02-14T16:15:51Z

Background

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	==Background==		==Background==
			[[File:1806 The Hypothalamus-Pituitary Complex.jpg\|thumb\|Pituitary gland anatomic relations.]]
	[[File:Pituiary gland - regulatory hormones.png\|thumb\|Pitutiary gland physiology.]]		[[File:Pituiary gland - regulatory hormones.png\|thumb\|Pitutiary gland physiology.]]
	*Loss of pituitary gland function due to hemorrhage or infarction of the gland		*Loss of pituitary gland function due to hemorrhage or infarction of the gland

Rossdonaldson1: /* Background */

2024-02-14T16:14:25Z

Background

← Older revision		Revision as of 16:14, 14 February 2024
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	==Background==		==Background==
			[[File:Pituiary gland - regulatory hormones.png\|thumb\|Pitutiary gland physiology.]]
	*Loss of pituitary gland function due to hemorrhage or infarction of the gland		*Loss of pituitary gland function due to hemorrhage or infarction of the gland
	**Uncommon endocrinological emergency, requires high level of suspicion based on history		**Uncommon endocrinological emergency, requires high level of suspicion based on history

Rossdonaldson1: /* Evaluation */

2024-02-14T16:10:47Z

Evaluation

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	==Evaluation==		==Evaluation==
			[[File:Pituitary apoplexy.jpg\|thumb\|MRI of a patient with pituitary apoplexy in presenting with headache and blindness. In center of MRI image in T1 sequence is a mass displacing optic chiasma.]]
	===Labs===		===Labs===
	*CBC		*CBC

Rossdonaldson1 at 16:09, 14 February 2024

2024-02-14T16:09:42Z

← Older revision		Revision as of 16:09, 14 February 2024
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	*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention		*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention

	==Risk Factors==		===Risk Factors===
	*Pituitary adenoma		*Pituitary adenoma
	*Trauma		*Trauma

Rossdonaldson1: /* References */

2024-02-14T16:05:51Z

References

← Older revision		Revision as of 16:05, 14 February 2024
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	==References==		==References==
	<references/>		<references/>

			[[Category:Endocrinology]]

Patricklin at 05:25, 8 December 2023

2023-12-08T05:25:13Z

← Older revision		Revision as of 05:25, 8 December 2023
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	==Background==		==Background==
	*~~Abrupt dysfunction~~ of ~~the~~ pituitary gland due to hemorrhage or infarction of the gland		*Loss of pituitary gland function due to hemorrhage or infarction of the gland
	**Uncommon endocrinological emergency, requires high level of suspicion based on history		**Uncommon endocrinological emergency, requires high level of suspicion based on history
	**Presentation may range from mild and insidious or severe and sudden		**Presentation may range from mild and insidious to severe and sudden
	*~~Usually~~, a pre-existing pituitary adenoma is involved		*In a majority of cases, a pre-existing pituitary adenoma is involved
	**Adenomas may compress upon blood supply; friability of the mass may lead to bleeding		**Adenomas may compress upon blood supply; friability of the mass may lead to bleeding
	*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention		*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention
Line 14:		Line 14:
	*Prior pituitary gland irradiation or instrumentation		*Prior pituitary gland irradiation or instrumentation
	*Prior cerebral angiography		*Prior cerebral angiography
	*Pregnancy ([[Sheehan's syndrome]]		*Pregnancy ([[Sheehan's syndrome]])
	*[[Anticoagulation]]		*[[Anticoagulation]]

Line 25:		Line 25:
	*[[Adrenal crisis]]		*[[Adrenal crisis]]
	*[[Altered mental status]]		*[[Altered mental status]]
			*Hypogonadism

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Correction of electrolyte abnormalities		*Correction of electrolyte abnormalities
	*[[Corticosteroids]], usually IV hydrocortisone bolus at 100-200mg, followed by drip at 2-4mg/hr<ref>Desai S, Seidler M. Metabolic & Endocrine Emergencies. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment: Emergency Medicine, 8e. McGraw Hill; 2017. Accessed December 07, 2023.</ref>		*[[Corticosteroids]], usually IV hydrocortisone bolus at 100-200mg, followed by drip at 2-4mg/hr<ref>Desai S, Seidler M. Metabolic & Endocrine Emergencies. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment: Emergency Medicine, 8e. McGraw Hill; 2017. Accessed December 07, 2023.</ref>
			*Consider thyroid hormone replacement
	*Neurosurgical consult for possible transsphenoidal decompression, if severe symptoms		*Neurosurgical consult for possible transsphenoidal decompression, if severe symptoms
	*Ophthalmology and endocrinology consults as appropriate		*Ophthalmology and endocrinology consults as appropriate

Patricklin: Created page with "==Background== Abrupt dysfunction of the pituitary gland due to hemorrhage or infarction of the gland Uncommon endocrinological emergency, requires high level of suspicion based on history Presentation may range from mild and insidious or severe and sudden Usually, a pre-existing pituitary adenoma is involved **Adenomas may compress upon blood supply; friability of the mass may lead to bleeding *Although several hormone axes may be deranged, HPA/adrenal and thyroid..."

2023-12-08T05:08:47Z

Created page with "==Background== *Abrupt dysfunction of the pituitary gland due to hemorrhage or infarction of the gland **Uncommon endocrinological emergency, requires high level of suspicion based on history **Presentation may range from mild and insidious or severe and sudden *Usually, a pre-existing pituitary adenoma is involved **Adenomas may compress upon blood supply; friability of the mass may lead to bleeding *Although several hormone axes may be deranged, HPA/adrenal and thyroid..."

New page

==Background==
*Abrupt dysfunction of the pituitary gland due to hemorrhage or infarction of the gland
**Uncommon endocrinological emergency, requires high level of suspicion based on history
**Presentation may range from mild and insidious or severe and sudden
*Usually, a pre-existing pituitary adenoma is involved
**Adenomas may compress upon blood supply; friability of the mass may lead to bleeding
*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention

==Risk Factors==
*Pituitary adenoma
*Trauma
*Recent endocrine stimulation testing
*Hormone modulators, including dopamine agonists, GnRH agonists
*Prior pituitary gland irradiation or instrumentation
*Prior cerebral angiography
*Pregnancy ([[Sheehan's syndrome]]
*[[Anticoagulation]]

==Clinical Features==
*[[Headache]], usually acute onset and retro-orbital or frontal
*Visual changes, including blurry vision, [[Visual field defects]], [[diplopia]], ophthalmoplegia
*[[Nausea and vomiting]]
*[[Fatigue]]
*[[Hypoglycemia]]
*[[Adrenal crisis]]
*[[Altered mental status]]

==Differential Diagnosis==
*[[Adrenal crisis]]
*[[Sepsis]]
*[[Sheehan's syndrome]]
{{Headache DDX}}

==Evaluation==
===Labs===
*CBC
*CMP
*[[Coagulation studies]]
*Hormone levels<ref>Almudena Vicente, Beatriz Lecumberri, María Ángeles Gálvez,
Clinical practice guideline for the diagnosis and treatment of pituitary apoplexy,
Endocrinología y Nutrición (English Edition), Volume 60, Issue 10, 2013, Pages 582.e1-582.e12, ISSN 2173-5093</ref>
**TSH, FT4
**Random cortisol
**LH/FSH
**Prolactin
**IGF-1
**Testosterone, estradiol
*LP may show a mixed picture, including xanthochromia and pleocytosis

===Imaging===
*[[Head CT]] without contrast
**Low sensitivity and may not detect acute findings. MRI required for confirmation of diagnosis
**May show sellar mass with active hemorrhage
*[[Brain MRI]]
**Identifies both hemorrhagic and ischemic/necrotic lesions, based on MRI sequence

==Management==
*IV fluids
*Correction of electrolyte abnormalities
*[[Corticosteroids]], usually IV hydrocortisone bolus at 100-200mg, followed by drip at 2-4mg/hr<ref>Desai S, Seidler M. Metabolic & Endocrine Emergencies. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment: Emergency Medicine, 8e. McGraw Hill; 2017. Accessed December 07, 2023.</ref>
*Neurosurgical consult for possible transsphenoidal decompression, if severe symptoms
*Ophthalmology and endocrinology consults as appropriate

==Disposition==
*Admit to floors vs ICU

==See Also==
[[Sheehan's syndrome]]

==External Links==

==References==
<references/>