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Pituitary Apoplexy Differential Diagnoses

  • Author: Michael S Vaphiades, DO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 23, 2015
 
 

Diagnostic Considerations

Acute ophthalmoplegia should be considered.

Pituitary apoplexy resulting in internal carotid artery occlusion has been reported due to the mass compressing the bilateral cavernous sinuses, resulting in obliteration of the cavernous portion of the right internal carotid artery.[16]

Isolated postoperative hyponatremia resistant to medical correction consider a central cause, in particular pituitary adenoma and/or apoplexy.[17]

Pituitary apoplexy is rarely associated with subarachnoid bleed and vasospasm, leading to cerebral infarcts and consequent focal neurologic deficits.[18]

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Michael S Vaphiades, DO Professor, Departments of Ophthalmology, Neurology, and Neurosurgery, Chief of Neuro-Ophthalmology and Electrophysiology Services, University of Alabama at Birmingham School of Medicine; Consulting Staff, Children's Hospital, Birmingham

Michael S Vaphiades, DO is a member of the following medical societies: American Academy of Neurology, North American Neuro-Ophthalmology Society, American Academy of Ophthalmology, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

References
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Enhanced coronal CT showing large pituitary tumor with a "snowman" configuration and heterogeneous density (mixed signal) within the tumor indicative of pituitary apoplexy. Hemorrhage was confirmed at surgery.
Enhanced axial and coronal T1-weighted MRI of a typical large pituitary tumor with a "snowman" configuration (coronal) and marked enhancement with contrast. This tumor has not undergone apoplexy.
Enhanced T1-weighted axial and coronal MRI showing a large pituitary tumor that has recently undergone ischemic apoplexy showing a necrotic (hypointense) center and ring of gadolinium enhancement (hyperintense), ie, the "pituitary ring sign." There is a small area of hemorrhagic blush in the center of the necrosis.
Automated visual field showing a bitemporal field defect due to compression of the optic chiasm from below.
 
 
 
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