Apoplexy is a medical term that refers to a cerebral hemorrhage or other sudden neurological impairment. Pituitary apoplexy occurs when a pituitary tumor (adenoma) either spontaneously hemorrhages or grows in such a way as to compress and cut off its own blood supply, resulting in tumor cell death, bleeding and acute swelling. The hemorrhage- or necrosis-induced swelling can compress the pituitary gland, optic nerves, and the nerves that control eye movement. Pituitary apoplexy is a medical emergency and can be fatal if untreated. With treatment, however, the prognosis is good.
Surgery is performed after medical stabilization. At UPMC, the preferred surgical treatment for pituitary apoplexy is the Endoscopic Endonasal Approach (EEA) to remove the tumor and decompress the area. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.
Pituitary apoplexy can be diagnosed by imaging studies such as head CT and MRI, along with lab studies to evaluate electrolyte, glucose, and pituitary hormone levels.
The physician will ask about symptoms, which often are sudden and severe. These may include:
- severe headache
- nausea
- vomiting
- visual loss/double vision
- loss of consciousness
- fever
- stiff neck
- hormone insufficiency
Once the patient has been medically stabilized, surgery is usually required to decompress the constricted areas and remove the tumor.
Pituitary apoplexies can be directly approached through the Endoscopic Endonasal Approach (EEA). This approach allows surgeons to see the pituitary gland well without making an open incision. The pituitary tumor removal and decompression are performed through the nose and nasal cavities, and recovery time is faster than with a traditional approach. The remaining pituitary gland is explored carefully to check for other lesions, and all abnormal tissue is removed.
