Pituitary apoplexy

Although pituitary apoplexy is uncommon, it is an endocrine emergency that demands prompt diagnosis and treatment. It arises during hemorrhagic necrosis in a pituitary tumor with accompanying severe headache, local compressive symptoms, and, usually, loss of endocrine function. Although no consensus exists about appropriate management, certain guidelines apply to all cases of pituitary apoplexy. Secondary adrenal insufficiency and visual field compromise must be excluded and, if present, treated appropriately. Neurosurgical consultation should be sought early in every case. However, there is no consensus about the use of conservative therapy vs. surgical decompression in pituitary apoplexy, and this issue merits a prospective study. Meanwhile, the management of pituitary apoplexy should be individualized and the approach modified depending on the neurosurgical expertise available and the degree to which endocrine function and vision are compromised.