Overview
Introduction
A patient with an abrupt retro orbital headache, vomiting, diplopia, or a new visual field defect may be experiencing pituitary apoplexy rather than an uncomplicated headache.
A patient with an abrupt retro-orbital headache, vomiting, diplopia, or a new visual-field defect may be experiencing pituitary apoplexy rather than an uncomplicated headache. Hemorrhage or infarction suddenly enlarges a pituitary lesion inside the confined sella turcica, where even a small change in pressure can affect the optic chiasm, cavernous-sinus cranial nerves, and remaining pituitary tissue. The immediate threat is loss of ACTH secretion: inadequate cortisol can produce hypotension, hypoglycemia, hyponatremia, and cardiovascular collapse. Obtain cortisol and ACTH before treatment only if the blood draw causes no delay; administer prescribed parenteral hydrocortisone as soon as apoplexy is suspected. MRI and serial neurologic and visual assessments then help define the lesion and determine whether urgent transsphenoidal decompression is needed.