Pituitary Apoplexy Differential Diagnoses

Updated: Jun 03, 2022
  • Author: Michael S Vaphiades, DO; Chief Editor: Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC  more...
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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. [22]

Isolated postoperative hyponatremia resistant to medical correction consider a central cause, in particular pituitary adenoma and/or apoplexy. [23]

Pituitary apoplexy rarely is associated with subarachnoid bleed and vasospasm, leading to cerebral infarcts and consequent focal neurologic deficits. [24]

From a prospectively collected database of patients treated at a tertiaty care center for pituitary adenoma, Martinez-Perez et al conducted a retrospective medical record review of apoplexy cases during the COVID-19 pandemic from March 2020 to December 2020 in addition to a literature review to identify other reported cases. Three consecutive cases of pituitary apoplexy and concomitant COVID-19 infection were identified. The most common symptoms at presentation were headache and vision changes. [25]  Ten cases of pituitary apoplexy in the setting of COVID-19 infection have been confirmed in the literature. [25]  

Differential Diagnoses