Pituitary apoplexy

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Pituitary apoplexy

Endocrine system


Pituitary apoplexy


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Pituitary apoplexy

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A 38-year-old woman comes to the emergency department because of a severe headache and multiple episodes of non-bloody, non-bilious emesis for the past few hours. Review of systems is significant for fatigue, constipation, and problems with peripheral field vision for the past few months. Her last menstrual period was 4 months ago. Temperature is 37.0°C (98.6°F), pulse is 58/min, respirations are 10/min, and blood pressure is 92/64 mm Hg. Physical examination shows a lethargic female complaining of severe pain. Visual field is tunneled with doubling of vision. Head magnetic resonance imaging is shown below:

Reproduced from: Wikimedia Commons

Which of the following is the most likely diagnosis?

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Focal neurological deficits

pituitary apoplexy p. 351

Headache p. 536

pituitary apoplexy p. 345

Pituitary apoplexy p. 345


With pituitary apoplexy, pituitary refers to a tiny gland at the base of the brain, and apoplexy refers to bleeding or loss of blood flow to an organ.

So, pituitary apoplexy is a disorder where there is either severe bleeding, or loss of blood flow to the pituitary gland, resulting in cell death and sudden loss of function.

Normally, the pituitary is a pea-sized gland, hanging by a stalk from the base of the brain.

It sits just behind the eyes near the optic chiasm, which is where the optic nerves cross.

The anterior pituitary, which is the front of the pituitary gland, contains a few different types of cells, each of which secretes a different hormone.

The largest group of cells are the somatotropes which secrete growth hormone, which goes on to promote tissue and organ growth.

The second largest cell group are the corticotrophs which secrete adrenocorticotropic hormone, or ACTH, which stimulates the adrenal glands to secrete cortisol, a hormone that controls the stress response, blood pressure, and metabolic regulation.

A smaller cell group are the lactotrophs which secrete prolactin.

Prolactin stimulates breast milk production, and also inhibits ovulation, which is when an egg cell is released from the ovary, and inhibits spermatogenesis, which is the development of sperm cells.

There are also thyrotrophs which are cells that secrete thyroid stimulating hormone, or TSH, that stimulate the thyroid gland.

And finally, there are the gonadotrophs which secrete two gonadotropic hormones - luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH, both of which go on to stimulate the ovaries or testes.


Pituitary apoplexy is a rare but serious condition that occurs when there is either severe bleeding or loss of blood flow to the pituitary gland, leading to acute dysfunction of the pituitary gland. It is a medical emergency and requires prompt diagnosis and treatment.

Symptoms of pituitary apoplexy include sudden onset of severe headache, vision changes, nausea and vomiting, loss of consciousness, and neurological symptoms such as weakness or numbness on one side of the body. Treatment involves medications to control the bleeding or inflammation, and surgery to remove the pituitary tumor, or in some cases, a portion of the skull to relieve pressure.


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  5. "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
  6. "Pituitary apoplexy" Indian Journal of Endocrinology and Metabolism (2011)
  7. "Pituitary apoplexy" Neurologia i Neurochirurgia Polska (2019)
  8. "Analytic Review: Pituitary Tumor Apoplexy: A Review" Journal of Intensive Care Medicine (2008)

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