Pituitary apoplexy history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Pituitary apoplexy usually has a short period of symptoms (acute), but it can be life-threatening. Symptoms usually include severe headache, paralysis of eye muscles, visual disturbances, nausea, and vomiting.

Obtaining a history gives important information in making a diagnosis of pituitary apoplexy. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. Pituitary apoplexy patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on onset, duration, and progression of symptoms such as:

• Headache
• Changes in vision or visual field
• Ptosis
• Medications
• Symptoms of other organ failure (adrenal failure)
• Co-morbid conditions like diabetes, immunodeficiency

Pituitary apoplexy usually has a short period of symptoms (acute), but it can be life-threatening. Symptoms usually include:^[1][2]

• Severe headache: It is generally the first symptom to appear (seen in 80% of patients).
• Paralysis of the eye muscles (ophthalmoplegia), causing double vision (diplopia). It can be due to an intracavernous expansion of the tumor mass or a sudden increase in pressure in the pituitary region.
• Visual disturbances from compression of surrounding structures (optic chiasm and optic tract).
• Extravasation of blood into subarachnoid space can lead to signs of meningeal irritation such as nausea, vomiting, photophobia, and meningismus.
• Low blood pressure, nausea, and vomiting from acute adrenal insufficiency.

Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions:

• Growth hormone deficiency
  • Fatigue
  • Increased abdominal fat
  • Lack of energy
• Hypoadrenalism (if not already present or treated)
  • Inability to deal with physical stress
  • Nausea
• Hypogonadism
  • Amenorrhea in women
  • Sexual dysfunction and loss of muscle mass in men
• Hypothyroidism
  • Cold intolerance
  • Constipation
  • Depressed mood
  • Dry skin
  • Fatigue
  • Hair or skin changes
  • Hoarseness
  • Menstrual changes
  • Mental slowing
  • Weight gain

When the posterior pituitary is involved (rare), symptoms may include:

• Failure of the uterus to contract as needed to give birth to a baby (in women)
• Failure to produce breast milk (in women)
• Uncontrolled urination

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