Management of Pituitary Apoplexy

In this article, we will discuss the Management of Pituitary Apoplexy. So, let’s get started.

Management

(1) Medical treatment of hypopituitarism: It invariably relieves pituitary apoplexy. Hydrocortisone 100 mg I.V. initially then every 6 to 8 hours until surgery is done. Acute adrenal insufficiency is common and an early finding in pituitary apoplexy. Electrolytes and fluid should be administered carefully to correct hydration and electrolyte balance. Patient should be watched closely for diabetes insipidus. In acute setting, other hormone replacement may not be required but subsequently steroids, thyroid hormone and gonadal hormones (testosterone in males, oestrogen and progesterone in females) may be required as replacement therapy for hypopituitarism on long term basis.

(2) Surgical treatment: Neurosurgical decompression via transphenoidal approach is definite therapy for pituitary apoplexy. Rapid down-hill course and severe visual loss are indications for surgery. Recent evidence suggests that only decompression may partially or completely restore the pituitary functions and lessen the need for hormonal replacement therapy.

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