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Pituitary Apoplexy
Karen L. Salzman, MD; Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Pituitary apoplexy (PA)
            • Synonyms

              • Pituitary necrosis; hemorrhage into pituitary mass
            • Definitions

              • Acute clinical syndrome with headache, visual defects/ophthalmoplegia, altered mental status, variable endocrine deficiencies
                • Caused by either hemorrhage or infarction of pituitary gland
                • Preexisting pituitary macroadenoma common

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Jung HN et al: Rathke cleft cysts with apoplexy-like symptoms: clinicoradiologic comparisons with pituitary adenomas with apoplexy. World Neurosurg. ePub, 2020
                                          2. Liu J et al: Clinicopathological analysis of 250 cases of pituitary adenoma under the new WHO classification. Oncol Lett. 19(3):1890-8, 2020
                                          3. Marzoughi S et al: Pearls & Oy-sters: Isolated oculomotor nerve palsy due to pituitary apoplexy missed on CT scan. Neurology. 94(16):e1774-7, 2020
                                          4. Pangal DJ et al: Pituitary apoplexy case series: outcomes after endoscopic endonasal transsphenoidal surgery at a single tertiary center. World Neurosurg. 137:e366-72, 2020
                                          5. Almeida JP et al: Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature. World Neurosurg. 130:e988-99, 2019
                                          6. Briet C et al: Pituitary apoplexy. Endocrinol Metab Clin North Am. 44(1):199-209, 2015
                                          7. Jahangiri A et al: Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement. Clin Neurol Neurosurg. 132:16-20, 2015
                                          8. Johnston PC et al: Pituitary tumor apoplexy. J Clin Neurosci. 22(6):939-44, 2015
                                          9. Boellis A et al: Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 5(6):753-62, 2014
                                          10. Jho DH et al: Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 82(5):781-90, 2014
                                          11. Rebeiz T et al: Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol. 71(2):226-7, 2014
                                          12. Rey-Dios R et al: Pituitary macroadenoma causing symptomatic internal carotid artery compression: surgical treatment through transsphenoidal tumor resection. J Clin Neurosci. 21(4):541-6, 2014
                                          13. Fanous AA et al: Giant necrotic pituitary apoplexy. J Clin Neurosci. 20(10):1462-4, 2013
                                          14. Sarwar KN et al: The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 98(6):2362-7, 2013
                                          15. Shirakawa J et al: Pituitary abscess with panhypopituitarism showing T1 signal hyperintensity of the marginal pituitary area: a non-invasive differential diagnosis of pituitary abscess and pituitary apoplexy. Intern Med. 48(6):441-6, 2009
                                          16. Kaplun J et al: Sequential pituitary MR imaging in Sheehan syndrome: report of 2 cases. AJNR Am J Neuroradiol. 29(5):941-3, 2008
                                          17. Semple PL et al: Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg. 108(5):909-15, 2008
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Pituitary apoplexy (PA)
                                                    • Synonyms

                                                      • Pituitary necrosis; hemorrhage into pituitary mass
                                                    • Definitions

                                                      • Acute clinical syndrome with headache, visual defects/ophthalmoplegia, altered mental status, variable endocrine deficiencies
                                                        • Caused by either hemorrhage or infarction of pituitary gland
                                                        • Preexisting pituitary macroadenoma common

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Angiographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Jung HN et al: Rathke cleft cysts with apoplexy-like symptoms: clinicoradiologic comparisons with pituitary adenomas with apoplexy. World Neurosurg. ePub, 2020
                                                                                  2. Liu J et al: Clinicopathological analysis of 250 cases of pituitary adenoma under the new WHO classification. Oncol Lett. 19(3):1890-8, 2020
                                                                                  3. Marzoughi S et al: Pearls & Oy-sters: Isolated oculomotor nerve palsy due to pituitary apoplexy missed on CT scan. Neurology. 94(16):e1774-7, 2020
                                                                                  4. Pangal DJ et al: Pituitary apoplexy case series: outcomes after endoscopic endonasal transsphenoidal surgery at a single tertiary center. World Neurosurg. 137:e366-72, 2020
                                                                                  5. Almeida JP et al: Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature. World Neurosurg. 130:e988-99, 2019
                                                                                  6. Briet C et al: Pituitary apoplexy. Endocrinol Metab Clin North Am. 44(1):199-209, 2015
                                                                                  7. Jahangiri A et al: Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement. Clin Neurol Neurosurg. 132:16-20, 2015
                                                                                  8. Johnston PC et al: Pituitary tumor apoplexy. J Clin Neurosci. 22(6):939-44, 2015
                                                                                  9. Boellis A et al: Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 5(6):753-62, 2014
                                                                                  10. Jho DH et al: Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 82(5):781-90, 2014
                                                                                  11. Rebeiz T et al: Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol. 71(2):226-7, 2014
                                                                                  12. Rey-Dios R et al: Pituitary macroadenoma causing symptomatic internal carotid artery compression: surgical treatment through transsphenoidal tumor resection. J Clin Neurosci. 21(4):541-6, 2014
                                                                                  13. Fanous AA et al: Giant necrotic pituitary apoplexy. J Clin Neurosci. 20(10):1462-4, 2013
                                                                                  14. Sarwar KN et al: The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 98(6):2362-7, 2013
                                                                                  15. Shirakawa J et al: Pituitary abscess with panhypopituitarism showing T1 signal hyperintensity of the marginal pituitary area: a non-invasive differential diagnosis of pituitary abscess and pituitary apoplexy. Intern Med. 48(6):441-6, 2009
                                                                                  16. Kaplun J et al: Sequential pituitary MR imaging in Sheehan syndrome: report of 2 cases. AJNR Am J Neuroradiol. 29(5):941-3, 2008
                                                                                  17. Semple PL et al: Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg. 108(5):909-15, 2008