Pituitary apoplexy


Pituitary gland anatomic relations.
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

Differential Diagnosis

Adrenal crisis






Aseptic Meningitis


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.


  • CBC
  • CMP
  • Coagulation studies
  • Hormone levels[1]
    • TSH, FT4
    • Random cortisol
    • LH/FSH
    • Prolactin
    • IGF-1
    • Testosterone, estradiol
  • LP may show a mixed picture, including xanthochromia and pleocytosis


  • 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


  • IV fluids
  • Correction of electrolyte abnormalities
  • Corticosteroids, usually IV hydrocortisone bolus at 100-200mg, followed by drip at 2-4mg/hr[2]
  • Consider thyroid hormone replacement
  • Neurosurgical consult for possible transsphenoidal decompression, if severe symptoms
  • Ophthalmology and endocrinology consults as appropriate


  • Admit to floors vs ICU

See Also

Sheehan's syndrome

External Links


  1. 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
  2. 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.