Pituitary Apoplexy Guidelines

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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Guidelines Summary

There are scoring systems that can aid in the treatment of pituitary apoplexy. [2, 45, 46]  Giritharan et al proposed a scoring system called the Pituitary Apoplexy Score (PAS), which ranges fron 0 to 10 and includes the level of consciousness, visual acuity, visual fields, and ocular paresis. [45]  Jho et al proposed another scoring system that stratifies into the following 5 grades: 

Grade 1: patients are asymptomatic with typical radiologic findings of pituitary apoplexy (subclinical);                                                                  Grade 2: patients have endocrinopathy with appropriate MRI findings with no other clinical symptoms;                                                                  Grade 3: patients with headache;                                                                                                                                                                              Grade 4: patients with ocular palsies; and                                                                                                                                                                           Grade 5: patients with visual deficits or altered sensorium. [2, 46]

As reported in the previous grading system, there was a trend toward surgical management in higher grade patients rather than lower grade patients. Both scoring systems, however, are not perfect.