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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

        • 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. Briet C et al: Pituitary apoplexy. Endocrinol Metab Clin North Am. 44(1):199-209, 2015
                                        2. 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
                                        3. Johnston PC et al: Pituitary tumor apoplexy. J Clin Neurosci. ePub, 2015
                                        4. Banerjee C et al: Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review. Pituitary. ePub, 2014
                                        5. Boellis A et al: Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 5(6):753-62, 2014
                                        6. Jho DH et al: Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 82(5):781-90, 2014
                                        7. Rebeiz T et al: Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol. 71(2):226-7, 2014
                                        8. 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
                                        9. Fanous AA et al: Giant necrotic pituitary apoplexy. J Clin Neurosci. 20(10):1462-4, 2013
                                        10. Sarwar KN et al: The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 98(6):2362-7, 2013
                                        11. 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
                                        12. Kaplun J et al: Sequential pituitary MR imaging in Sheehan syndrome: report of 2 cases. AJNR Am J Neuroradiol. 29(5):941-3, 2008
                                        13. 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

                                              • 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. Briet C et al: Pituitary apoplexy. Endocrinol Metab Clin North Am. 44(1):199-209, 2015
                                                                              2. 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
                                                                              3. Johnston PC et al: Pituitary tumor apoplexy. J Clin Neurosci. ePub, 2015
                                                                              4. Banerjee C et al: Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review. Pituitary. ePub, 2014
                                                                              5. Boellis A et al: Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 5(6):753-62, 2014
                                                                              6. Jho DH et al: Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 82(5):781-90, 2014
                                                                              7. Rebeiz T et al: Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol. 71(2):226-7, 2014
                                                                              8. 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
                                                                              9. Fanous AA et al: Giant necrotic pituitary apoplexy. J Clin Neurosci. 20(10):1462-4, 2013
                                                                              10. Sarwar KN et al: The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 98(6):2362-7, 2013
                                                                              11. 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
                                                                              12. Kaplun J et al: Sequential pituitary MR imaging in Sheehan syndrome: report of 2 cases. AJNR Am J Neuroradiol. 29(5):941-3, 2008
                                                                              13. Semple PL et al: Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg. 108(5):909-15, 2008