Pituitary apoplexy- A potentially fatal condition
DESCRIPTION
Pituitary apoplexy is an unusual condition that is often fatal. It has a male predisposition and a mean age of onset around 57 years.[1] It usually occurs in patients with pre-existing pituitary mass lesion like macroadenoma, which undergoes a hemorrhagic infarction in the lesion. The patient presents with acute headache, visual impairment, altered mental status, vomiting and panhypopituitarism.[2,3,4] The patient may directly present with the complications without being previously diagnosed with macroadenoma. The most common presentation is sudden onset headache, mainly retro-orbital, which may be confused with thunderclap headache. This presentation may make the clinician suspect SAH.[5] The second most common presenting feature is a visual deficit, followed by vomiting, nausea, and neurological deficits. The computerised tomography (CT) of the head usually shows sellar enlargement with an expansile pituitary lesion. There are areas of patchy or confluent hyperdensities within the lesion. There may also be layering in the lesion, possibly due to different densities of blood products. The patient may have a haemorrhage in the adenoma without being symptomatic; in such conditions, the term pituitary apoplexy is not used. A 49-year old female presented with a severe headache. She was previously diagnosed with pituitary macroadenoma, for which she did not take any treatment. She was advised unenhanced CT scan of the head. A large well-defined oval-shaped lesion was seen in the pituitary gland with internal areas of haemorrhage forming blood-fluid levels [white arrow in Figure 1(A) & (B)].
LEARNING POINTS/TAKE HOME MESSAGES
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Pituitary apoplexy is mostly a complication of patients with pre-existing macroadenoma.
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Headache, visual impairment, vomiting, altered mental status are the common presenting symptoms of pituitary apoplexy.
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CT is the first investigation done in suspected pituitary apoplexy, which will reveal internal haemorrhage.
REFERENCES
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