UMEM Educational Pearls

Category: Neurology

Title: Pituitary Apoplexy

Keywords: pituitary apoplexy, subarachnoid hemorrhage, SAH, headache, ophthalmoplegia (PubMed Search)

Posted: 11/28/2007 by Aisha Liferidge, MD (Updated: 7/10/2020)
Click here to contact Aisha Liferidge, MD

Today's joint conference with the UMMS' Neurology Department was quite beneficial and applicable to our daily practice in the Emergency Department (ED).

The topics discussed included:

  • Third Nerve Palsy (aneurysmal versus vasculopathic)
  • Painful Post-ganglionic Horner's Syndrome
  • Cluster Headache
  • Carotid Dissection
  • Pituitary Apolplexy

While the information provided for each of these clinical topics was comprehensive, be sure to review these disorders in the near future, in order to commit them to memory and increase your comfort level with diagnosing and treating them in the ED.  If you'd like a copy of the handouts, just let me know.

Today's pearl will highlight pituitary apoplexy.

Take Home Points about Pituitary Apoplexy:

  • Defined as hemorrhage or infarction of a pituitary tumor.
  • Neurologic emergency that can be fatal, usually due to hemorrhage.
  • Typically presents with acute onset of headache +/- meningeal irritation, altered mental status,  photophobia, and  ophthalmoplegia (usually 3rd cranial nerve palsy, followed by 6th and 4th cranial nerve dyfunction).
  • CT head (dry) may appear normal.  MRI typically makes the diagnosis.
  • Ophthalmoplegia (of 3rd CN) + CSF with significant red cells may prompt an angiogram in search of a PCOM (posterior communicating artery) aneurysm, when an MRI is acutally all that's needed.
  • Treatment:  high dose steroids (hydrocortisone 100 mg IV q 6-8 h) +/- decompressive surgery via Neurosurgery.