Medication Summary

As corticotropic deficiency is present in most patients with pituitary apoplexy and may be life-threatening,^[26]the goals of pharmacotherapy are to correct the corticosteroid deficiency, to reduce morbidity, and to prevent complications.

In one study, 84% of patients developed one or more anterior pituitary hormone deficiency, 74% were diagnosed with severe growth hormone deficiency, and 68% required long-term steroid replacement. Sixty-five percent were deficient in both thyroxine and also gonadotrophin. No patients had long-term diabetes insipidus. Overall, the rates of hypopituitarism at follow-up were similar between the emergency surgical, elective surgical, and the conservative treatment groups^[45].

Class Summary

Corticosteroids replenish the cortisol that would normally be produced under this type of physiologic stressful situation.

Hydrocortisone (Hydrocortone, Cortef, Solu-Cortef)

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Hydrocortisone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Questions

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Media Gallery

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.
Post-contrast sagittal T1-weighted scan shows sphenoid sinus roof mucosal thickening. The yellow arrow shows the “pituitary ring sign,” while the white arrow shows sphenoid sinus roof mucosal thickening. Courtesy of Taylor & Francis (Vaphiades MS. Pituitary Ring Sign Plus Sphenoid Sinus Mucosal Thickening: Neuroimaging Signs of Pituitary Apoplexy. Neuroophthalmology. 2017 Dec. 41 (6):306-309. Online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764063/.).