Pituitary apoplexy results from hemorrhage or infarction in a pituitary adenoma; it can occur spontaneously or after head trauma. In its most dramatic presentation, apoplexy causes the sudden onset of excruciating headache, visual field loss, diplopia due to pressure on the oculomotor nerves, and hypopituitarism. Any type of pituitary hormone deficiency can occur, but cortisol deficiency is the most serious because it can cause life-threatening hypotension. Imaging of the pituitary may show intra-adenomal hemorrhage and deviation of the pituitary stalk. Most patients recover but experience long-term pituitary insufficiency. Signs of reduced vision and altered mental status are indications for transsphenoidal surgical decompression. Ophthalmologists need to be aware of this entity because of the high incidence of visual symptoms on presentation.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.