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Pathophysiology of Pituitary Apoplexy

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

Pathophysiology

Hemorrhage and necrosis of the pituitary adenoma are the cardinal pathological features of pituitary apoplexy and occur due to:

1. Pituitary adenomas are more vulnerable to bleeding than other tumors.

2. A rapidly growing adenoma outstripes its blood supply and produces ischemia followed by necrosis and secondary hemorrhage.

3. Compression of a large pituitary stalk carrying blood vessels by an expanding tumor mass may render the entire anterior lobe ischemic followed by secondary hemorrhage.

4. Fragility of the tumor blood vessels predispose to bleeding.

5. Sheehan syndrome (pituitary necrosis following postpartum uterine hemorrhage) is characterized by amenorrhea and inability to lactate. Hypopituitarism develops acutely usually with severe secondary adrenal insufficiency.

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Clinical Presentations of Pituitary Apoplexy

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

Signs and Symptoms

  • Headache, sudden and severe retro-orbital and frontal pain
  • Decreased visual acquity and visual field defects
  • Opthalmoplegia, ptosis, and pupilary defects
  • Nausea, vomiting, headache, alteration in the level of consciousness, e.g. lethargy, stupor, and coma
  • Hemiplegia
  • Acute adrenal insufficiency
  • Gonadal dysfunction
  • Diabetes insipidus
  • Hypofunction of thyroid
  • Fever, anosmia, CSF rhinorrhea, and facial pain, respiratory and cardiac rhythm disturbances

Structure involved/compressed

  • Sudden enlargement of tumor mass
  • Optic nerve
  • The III,IV, and VI cranial nerve compression
  • Meningeal irritation (disruption of dura or leakage of blood into subarachnoid space)
  • Internal carotid artery
  • Compression of corticotrophs (loss of ACTH)
  • Compression of gonadotrophs (loss of LH, FSH)
  • Compression of pituitary stalk
  • Compression of thyrotrophs
  • Nonspecific, noncompressive

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