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UK guidelines for the management of pituitary apoplexy a rare but potentially fatal medical emergency
  1. Mark Vanderpump1,
  2. Clare Higgens2,
  3. John A H Wass3
  1. 1Department of Endocrinology, Royal Free Hampstead NHS Trust, London, UK
  2. 2Department of Medicine, Northwick Park and St Marks Hospitals, Northwest London NHS Trust, Harrow, London, UK
  3. 3Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, The Churchill Hospital, Oxford, UK
  1. Correspondence to Dr MPJ Vanderpump, Department of Endocrinology, Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK; mark.vanderpump{at}nhs.net

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Classic pituitary apoplexy is rare. It occurs in approximately 5% of patients with a pituitary tumour, and for 80% of apoplexy patients is the first presentation of the tumour, although subtle symptoms (eg, of hypogonadism) may have been present for some years. It is important because delays can occur in the diagnosis, which may be associated with morbidity and even mortality.1 Furthermore, early multidisciplinary intervention can improve outcomes in terms of visual function.

It is characterised by the sudden onset of severe headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage or infarction of the pituitary gland. These clinical manifestations of pituitary apoplexy are caused by a rapid increase in intrasellar pressure.2 Lateral compression can affect the contents of the cavernous sinus leading to ocular palsies in nearly 70% of patients.3 4 The third cranial (oculomotor) nerve is the most common nerve to be affected. Decreased visual acuity and visual field defects, specifically bitemporal hemianopia are seen in nearly 75% of patients and are caused by upward enlargement of the intrasellar contents, leading to …

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