Pituitary apoplexy
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Pituitary apoplexy
Pathology
Adrenal gland disorders
Congenital adrenal hyperplasia
Primary adrenal insufficiency
Waterhouse-Friderichsen syndrome
Hyperaldosteronism
Adrenal cortical carcinoma
Cushing syndrome
Conn syndrome
Thyroid gland disorders
Thyroglossal duct cyst
Hyperthyroidism
Graves disease
Thyroid eye disease (NORD)
Toxic multinodular goiter
Thyroid storm
Hypothyroidism
Euthyroid sick syndrome
Hashimoto thyroiditis
Subacute granulomatous thyroiditis
Riedel thyroiditis
Postpartum thyroiditis
Thyroid cancer
Parathyroid gland disorders
Hyperparathyroidism
Hypoparathyroidism
Hypercalcemia
Hypocalcemia
Pancreatic disorders
Diabetes mellitus
Diabetic retinopathy
Diabetic nephropathy
Pituitary gland disorders
Hyperpituitarism
Pituitary adenoma
Hyperprolactinemia
Prolactinoma
Gigantism
Acromegaly
Hypopituitarism
Growth hormone deficiency
Pituitary apoplexy
Sheehan syndrome
Hypoprolactinemia
Constitutional growth delay
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Gonadal dysfunction
Precocious puberty
Delayed puberty
Premature ovarian failure
Polycystic ovary syndrome
Androgen insensitivity syndrome
Kallmann syndrome
5-alpha-reductase deficiency
Polyglandular syndromes
Autoimmune polyglandular syndrome type 1 (NORD)
Endocrine tumors
Multiple endocrine neoplasia
Pancreatic neuroendocrine neoplasms
Zollinger-Ellison syndrome
Carcinoid syndrome
Pheochromocytoma
Neuroblastoma
Opsoclonus myoclonus syndrome (NORD)
Endocrine system pathology review
Adrenal insufficiency: Pathology review
Adrenal masses: Pathology review
Hyperthyroidism: Pathology review
Hypothyroidism: Pathology review
Thyroid nodules and thyroid cancer: Pathology review
Parathyroid disorders and calcium imbalance: Pathology review
Diabetes mellitus: Pathology review
Cushing syndrome and Cushing disease: Pathology review
Pituitary tumors: Pathology review
Hypopituitarism: Pathology review
Diabetes insipidus and SIADH: Pathology review
Multiple endocrine neoplasia: Pathology review
Neuroendocrine tumors of the gastrointestinal system: Pathology review
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Pituitary apoplexy
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USMLE® Step 1 style questions USMLE
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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
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Transcript
Contributors
Jahnavi Narayanan, MBBS
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.
Summary
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.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Harrison's Endocrinology, 4E" McGraw-Hill Education / Medical (2016)
- "Pituitary apoplexy" Indian Journal of Endocrinology and Metabolism (2011)
- "Pituitary apoplexy" Neurologia i Neurochirurgia Polska (2019)
- "Analytic Review: Pituitary Tumor Apoplexy: A Review" Journal of Intensive Care Medicine (2008)
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