Ver el código de «Pituitary apoplexy»

==Background==
[[File:1806 The Hypothalamus-Pituitary Complex.jpg|thumb|Pituitary gland anatomic relations.]]
[[File:Pituiary gland - regulatory hormones.png|thumb|Pitutiary gland physiology.]]
*Loss of pituitary gland function due to hemorrhage or infarction of the gland
**Uncommon endocrinological emergency, requires high level of suspicion based on history
**Presentation may range from mild and insidious to severe and sudden
*In a majority of cases, a pre-existing pituitary adenoma is involved
**Adenomas may compress upon blood supply; friability of the mass may lead to bleeding
*Although several hormone axes may be deranged, HPA/adrenal and thyroid axes likely require the most immediate attention

===Risk Factors===
*Pituitary adenoma
*Trauma
*Recent endocrine stimulation testing
*Hormone modulators, including dopamine agonists, GnRH agonists
*Prior pituitary gland irradiation or instrumentation
*Prior cerebral angiography
*Pregnancy ([[Sheehan's syndrome]])
*[[Anticoagulation]]

==Clinical Features==
*[[Headache]], usually acute onset and retro-orbital or frontal
*Visual changes, including blurry vision, [[Visual field defects]], [[diplopia]], ophthalmoplegia
*[[Nausea and vomiting]]
*[[Fatigue]]
*[[Hypoglycemia]]
*[[Adrenal crisis]]
*[[Altered mental status]]
*Hypogonadism

==Differential Diagnosis==
{{Adrenal crisis ddx}}
{{Headache DDX}}

==Evaluation==
[[File:Pituitary apoplexy.jpg|thumb|MRI of a patient with pituitary apoplexy in presenting with headache and blindness. In center of MRI image in T1 sequence is a mass displacing optic chiasma.]]
===Labs===
*CBC
*CMP
*[[Coagulation studies]]
*Hormone levels<ref>Almudena Vicente, Beatriz Lecumberri, María Ángeles Gálvez,
Clinical practice guideline for the diagnosis and treatment of pituitary apoplexy,
Endocrinología y Nutrición (English Edition), Volume 60, Issue 10, 2013, Pages 582.e1-582.e12, ISSN 2173-5093</ref>
**TSH, FT4
**Random cortisol
**LH/FSH
**Prolactin
**IGF-1
**Testosterone, estradiol
*LP may show a mixed picture, including xanthochromia and pleocytosis

===Imaging===
*[[Head CT]] without contrast
**Low sensitivity and may not detect acute findings. MRI required for confirmation of diagnosis
**May show sellar mass with active hemorrhage
*[[Brain MRI]]
**Identifies both hemorrhagic and ischemic/necrotic lesions, based on MRI sequence

==Management==
*IV fluids
*Correction of electrolyte abnormalities
*[[Corticosteroids]], usually IV hydrocortisone bolus at 100-200mg, followed by drip at 2-4mg/hr<ref>Desai S, Seidler M. Metabolic & Endocrine Emergencies. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment: Emergency Medicine, 8e. McGraw Hill; 2017. Accessed December 07, 2023.</ref>
*Consider thyroid hormone replacement
*Neurosurgical consult for possible transsphenoidal decompression, if severe symptoms
*Ophthalmology and endocrinology consults as appropriate

==Disposition==
*Admit to floors vs ICU

==Medication Dosing==
{{MedicationDose
| drug = Hydrocortisone
| dose = 100-200mg IV bolus, then 2-4mg/hr infusion
| route = IV
| context = Stress-dose corticosteroid replacement
| indication = Pituitary apoplexy
| population = Adult
}}

==See Also==
[[Sheehan's syndrome]]

==External Links==

==References==
<references/>

[[Category:Endocrinology]]