Pituitary apoplexy
Pituitary apoplexy is a rare, but serious condition of the pituitary gland.
Causes
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.
Benign
Benign refers to a condition, tumor, or growth that is not cancerous. This means that it does not spread to other parts of the body. It does not in...
Read Article Now Book Mark ArticleWhen pituitary bleeding occurs in a woman during or right after childbirth, it is called Sheehan syndrome. This is a very rare condition.
Sheehan syndrome
Sheehan syndrome is a condition that can occur in a woman who bleeds severely during childbirth. Sheehan syndrome is a type of hypopituitarism....
Read Article Now Book Mark ArticleRisk factors for pituitary apoplexy in non-pregnant people without a tumor include:
- Bleeding disorders
- Diabetes
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark Article - Head injury
- Radiation to the pituitary gland
- Use of a breathing machine
Pituitary apoplexy in these situations is very rare.
Symptoms
Pituitary apoplexy usually has a short period of symptoms (acute), which can be life threatening. Symptoms often include:
- Severe headache (worst of your life)
- Paralysis of the eye muscles, causing double vision (ophthalmoplegia) or problems opening an eyelid
Ophthalmoplegia
Supranuclear ophthalmoplegia is a condition that affects the movement of the eyes.
Read Article Now Book Mark Article - Loss of peripheral vision or loss of all vision in one or both eyes
- Low blood pressure, nausea, loss of appetite, and vomiting from acute adrenal insufficiency
Acute adrenal insufficiency
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands...
Read Article Now Book Mark Article - Personality changes due to sudden narrowing or spasm of one of the arteries in the brain (anterior cerebral artery)
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 after delivery.
Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions:
- Growth hormone deficiency
Growth hormone deficiency
Growth hormone deficiency means the pituitary gland does not make enough growth hormone.
Read Article Now Book Mark Article - Adrenal insufficiency (if not already present or treated)
- Hypogonadism (body's sex glands produce little or no hormones)
Hypogonadism
Hypogonadism occurs when the body's sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands ...
Read Article Now Book Mark Article - Hypothyroidism (thyroid gland does not make enough thyroid hormone)
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
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In rare cases, when the posterior (back part) of the pituitary is involved, symptoms may include:
- Failure of the uterus to contract to give birth to a baby (in women)
- Failure to produce breast milk (in women)
- Frequent urination and severe thirst (diabetes insipidus)
Diabetes insipidus
Diabetes insipidus (DI) is an uncommon condition in which the kidneys are unable to prevent the excretion of water. DI is not the same as diabetes me...
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Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms.
Tests that may be ordered include:
- Eye exams
- MRI or CT scan
MRI
A magnetic resonance imaging (MRI) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the body. It does not us...
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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Blood tests will be done to check levels of:
- ACTH (adrenocorticotropic hormone)
ACTH
The ACTH test measures the level of adrenocorticotropic hormone (ACTH) in the blood. ACTH is a hormone released from the pituitary gland at the base...
Read Article Now Book Mark Article - Cortisol
Cortisol
The cortisol blood test measures the level of cortisol in the blood. Cortisol is a steroid (glucocorticoid or corticosteroid) hormone produced by th...
Read Article Now Book Mark Article - FSH (follicle-stimulating hormone)
FSH
The follicle stimulating hormone (FSH) blood test measures the level of FSH in blood. FSH is a hormone released by the pituitary gland, located on t...
Read Article Now Book Mark Article - Growth hormone
Growth hormone
The growth hormone test measures the amount of growth hormone in the blood. The pituitary gland makes growth hormone, which causes a child to grow. ...
Read Article Now Book Mark Article - LH (luteinizing hormone)
Luteinizing hormone
The LH blood test measures the amount of luteinizing hormone (LH) in blood. LH is a hormone released by the pituitary gland, located on the undersid...
Read Article Now Book Mark Article - Prolactin
Prolactin
Prolactin is a hormone released by the pituitary gland. The prolactin test measures the amount of prolactin in the blood.
Read Article Now Book Mark Article -
TSH (thyroid-stimulating hormone)
Thyroid-stimulating hormone
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
Read Article Now Book Mark Article - Insulin-like growth factor-1 (IGF-1)
- Sodium
- Osmolarity in blood and urine
Treatment
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:
- Growth hormone
- Sex hormones (estrogen/testosterone)
- Thyroid hormone
- Vasopressin (ADH)
Outlook (Prognosis)
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.
Possible Complications
Complications of untreated pituitary apoplexy can include:
- Adrenal crisis (condition that occurs when there is not enough cortisol, a hormone produced by the adrenal glands)
Adrenal crisis
Acute adrenal crisis is a life-threatening condition that occurs when there is not enough cortisol. This is a hormone produced by the adrenal glands...
Read Article Now Book Mark ArticleAdrenal glands
The adrenal glands are two small triangle-shaped glands in the upper abdomen. One gland is located on top of each kidney.
Read Article Now Book Mark Article - Vision loss
If other missing hormones are not replaced, symptoms of hypothyroidism and hypogonadism may develop, including infertility.
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
Read Article Now Book Mark ArticleHypogonadism
Hypogonadism occurs when the body's sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands ...
Read Article Now Book Mark ArticleWhen to Contact a Medical Professional
Contact 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:
- Eye muscle weakness or vision loss
- Sudden, severe headache
- Low blood pressure (which can cause fainting)
- Nausea
- Vomiting
If you develop these symptoms and you have already been diagnosed with a pituitary tumor, seek medical help right away.
Reviewed By
Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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 29, 2023.
Melmed S. Pituitary masses and tumors. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 9.