ABSTRACT
For reasons not entirely understood, both large and small pituitary adenomas have a tendency to either bleed or infarct spontaneously, causing pituitary apoplexy.15 The vascular insult usually occurs spontaneously but may result from cerebral angiography or during provocative endocrine testing; it also occurs with greater frequency during pregnancy. The result is sudden enlargement of the pituitary tumor and spillage of hemorrhagic or necrotic material into the suprasellar cistern and the subarachnoid space. The clinical symptoms include sudden onset of visual loss, ocular palsies, acute hypopituitarism, and alteration in consciousness varying from confusion to coma. Fever and nuchal rigidity may suggest the diagnosis of bacterial or viral meningitis. The CSF may contain blood or white cells, the latter in response to spilled necrotic material. Most patients respond to conservative treatment, replacing absent hormones and using corticosteroids to suppress inflammation. In some patients, emergency decompression of the enlarged pituitary is necessary to relieve symptoms. Untreated pituitary apoplexy can be fatal.
