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Diagnosis and Treatment of Pituitary Apoplexy, A True Endocrine Emergency

2024; Elsevier BV; Volume: 55; Issue: 4 Linguagem: Inglês

10.1016/j.arcmed.2024.103001

1873-5487

Alberto Moscona-Nissan, Jessica Sidauy-Adissi, Karla Ximena Hermoso-Mier, Shimon Shlomo Glick-Betech, Leonel de Jesús Chávez-Vera, Florencia Martínez-Mendoza, Oscar Mario Delgado-Casillas, Keiko Taniguchi‐Ponciano, Daniel Marrero‐Rodríguez, Moisés Mercado,

Adrenal Hormones and Disorders

Pituitary apoplexy (PA) is a clinical syndrome resulting from a hemorrhagic infarction of the pituitary gland. It is characterized by the sudden onset of visual disturbances, nausea, vomiting, headache and occasionally, signs of meningeal irritation and an altered mental status. The exact pathogenesis of PA remains to be elucidated, although tumor overgrowth of its blood supply remains the most popular theory. Main risk factors for the development of PA include systemic, iatrogenic, and external factors as well as the presence of an underlying pituitary tumor. The diagnostic approach of PA includes both neuroimaging and evaluation of pituitary secretory function. PA is a potentially life-threatening condition which should be managed with hemodynamic stabilization, correction of electrolyte abnormalities and replacement of hormonal deficiencies. PA treatment should be individualized based on the severity of the clinical picture which may vary widely. Treatment options include conservative management with periodic follow-up or neurosurgical intervention, which should be decided by a multidisciplinary team. We conducted a systematic review of the literature to unveil the frequency of PA predisposing factors, clinical and biochemical presentations, management strategies and outcomes.