Pituitary Apoplexy Questions & Answers

1. Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med. 2008 Mar-Apr. 23(2):75-90. [QxMD MEDLINE Link].

2. Muthukumar N. Pituitary Apoplexy: A Comprehensive Review. Neurol India. 2020. 68(Supplement):S72-S78. [QxMD MEDLINE Link]. [Full Text].

3. Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol. 1982 Sep. 18(3):181-9. [QxMD MEDLINE Link].

4. Kurisu K, Kawabori M, Niiya Y, Ohta Y, Mabuchi S, Houkin K. Pituitary apoplexy manifesting as massive intracerebral hemorrhage. Case report. Neurol Med Chir (Tokyo). 2012. 52(8):587-90. [QxMD MEDLINE Link].

5. Culpin E, Crank M, Igra M, Connolly DJA, Dimitri P, Mirza S, et al. Pituitary tumour apoplexy within prolactinomas in children: a more aggressive condition?. Pituitary. 2018 Oct. 21 (5):474-479. [QxMD MEDLINE Link].

6. Giritharan S, Gnanalingham K, Kearney T. Pituitary apoplexy - bespoke patient management allows good clinical outcome. Clin Endocrinol (Oxf). 2016 Sep. 85 (3):415-22. [QxMD MEDLINE Link].

7. Mou C, Han T, Zhao H, Wang S, Qu Y. Clinical features and immunohistochemical changes of pituitary apoplexy. J Clin Neurosci. 2009 Jan. 16(1):64-8. [QxMD MEDLINE Link].

8. Simsek Bagir G, Civi S, Kardes O, Kayaselcuk F, Ertorer ME. Stubborn hiccups as a sign of massive apoplexy in a naive acromegaly patient with pituitary macroadenoma. Endocrinol Diabetes Metab Case Rep. 2017. 2017:[QxMD MEDLINE Link].

9. Bahmani Kashkouli M, Khalatbari MR, Yahyavi ST, Borghei-Razavi H, Soltan-Sanjari M. Pituitary apoplexy presenting as acute painful isolated unilateral third cranial nerve palsy. Arch Iran Med. 2008 Jul. 11(4):466-8. [QxMD MEDLINE Link].

10. Hori A. Suprasellar peri-infundibular ectopic adenohypophysis in fetal and adult brains. J Neurosurg. 1985 Jul. 63(1):113-5. [QxMD MEDLINE Link].

11. Ly S, Naman A, Chaufour-Higel B, Patey M, Arndt C, Delemer B, et al. Pituitary apoplexy and rivaroxaban. Pituitary. 2017 Aug 22. [QxMD MEDLINE Link].

12. Okuda O, Umezawa H, Miyaoka M. Pituitary apoplexy caused by endocrine stimulation tests: a case report. Surg Neurol. 1994 Jul. 42(1):19-22. [QxMD MEDLINE Link].

13. Silberstein L, Johnston C, Bhagat A, Tibi L, Harrison J. Pituitary apoplexy during induction chemotherapy for acute myeloid leukaemia. Br J Haematol. 2008 Oct. 143(2):151. [QxMD MEDLINE Link].

14. Thurtell MJ, Besser M, Halmagyi GM. Pituitary apoplexy causing isolated blindness after cardiac bypass surgery. Arch Ophthalmol. 2008 Apr. 126(4):576-8. [QxMD MEDLINE Link].

15. Brar KS, Garg MK. High altitude-induced pituitary apoplexy. Singapore Med J. 2012 Jun. 53(6):e117-9. [QxMD MEDLINE Link].

16. Kumar V, Kataria R, Mehta VS. Dengue hemorrhagic fever: A rare cause of pituitary tumor hemorrhage and reversible vision loss. Indian J Ophthalmol. Jul-Aug /2011. 59:311-2. [QxMD MEDLINE Link].

17. Kruljac I, Cerina V, Pecina HI, et al. Pituitary metastasis presenting as ischemic pituitary apoplexy following heparin-induced thrombocytopenia. Endocr Pathol. 2012 Dec. 23(4):264-7. [QxMD MEDLINE Link].

18. Vaphiades M. The "pituitary ring sign": An MRI sign of pituitary apoplexy. Neuro-ophthalmology. 2007. 31:111-6.

19. Weisberg LA. Pituitary apoplexy. Association of degenerative change in pituitary ademona with radiotherapy and detection by cerebral computed tomography. Am J Med. 1977 Jul. 63(1):109-15. [QxMD MEDLINE Link].

20. Ahmed SK, Semple PL. Cerebral ischemia in pituitary apoplexy. Acta Neurochir. 2008. 150:1193-6.

21. Pineyro MM, Furtenbach P, Lima R, Wajskopf S, Sgarbi N, Pisabarro R. Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy. Front Endocrinol (Lausanne). 2017. 8:192. [QxMD MEDLINE Link].

22. Chokyu I, Tsuyuguchi N, Goto T, Chokyu K, Chokyu M, Ohata K. Pituitary apoplexy causing internal carotid artery occlusion--case report. Neurol Med Chir (Tokyo). 2011. 51:48-51. [QxMD MEDLINE Link].

23. Madhusudhan S, Madhusudhan TR, Haslett RS, Sinha A. Pituitary apoplexy following shoulder arthroplasty: a case report. J Med Case Rep. 2011 Jul 5. 5:284. [QxMD MEDLINE Link]. [Full Text].

24. Mohindra S, Kovai P, Chhabra R. Fatal Bilateral ACA Territory Infarcts after Pituitary Apoplexy: A Case Report and Literature Review. Skull Base. 2010 Jul. 20(4):285-8. [QxMD MEDLINE Link]. [Full Text].

25. Martinez-Perez R, Kortz MW, Carroll BW, Duran D, Neill JS, Luzardo GD, et al. Coronavirus Disease 2019 and Pituitary Apoplexy: A Single-Center Case Series and Review of the Literature. World Neurosurg. 2021 Jun 12. 21:S1878-8750. [QxMD MEDLINE Link]. [Full Text].

26. Briet C, Salenave S, Chanson P. Pituitary Apoplexy. Endocrinol Metab Clin North Am. 2015 Mar. 44(1):199-209. [QxMD MEDLINE Link].

27. Binning MJ, Liu JK, Gannon BS, Osborn AG, Couldwell WT. Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy. J Neurosurg. 2008. 108:3-8.

28. Kaplun J, Fratila C, Ferenczi A, Yang WC, Lantos G, Fleckman AM. Sequential pituitary MR imaging in Sheehan syndrome: report of 2 cases. AJNR Am J Neuroradiol. 2008 May. 29(5):941-3. [QxMD MEDLINE Link].

29. Liu S, Wang X, Liu YH, Mao Q. Spontaneous disappearance of the pituitary macroadenoma after apoplexy: a case report and review of the literature. Neurol India. 2012 Sep-Oct. 60(5):530-2. [QxMD MEDLINE Link].

30. Lavalee G, Morcos R, Palardy J, Aube M, Gilbert D. MR of nonhemorrhagic post-partum pituitary apoplexy. AJNR Am J Neuroradiol. 1995. 16:1939-41.

31. Kleinschmidt-DeMasters BK, Lillehei KO. Pathological correlates of pituitary adenomas presenting with apoplexy. Hum Pathol. 1998 Nov. 29 (11):1255-65. [QxMD MEDLINE Link].

32. Vaphiades MS. The "pituitary ring sign": An MRI sign of pituitary apoplexy. Neuro-Ophthalmology. 2007. 31:111-6.

33. Vaphiades MS, Simmons D, Archer RL, Stringer W. Sheehan syndrome: a splinter of the mind. Surv Ophthalmol. 2003 Mar-Apr. 48 (2):230-3. [QxMD MEDLINE Link].

34. Arita K, Kurisu K, Tominaga A, Sugiyama K, Ikawa F, Yoshioka H, et al. Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy. J Neurosurg. 2001 Nov. 95 (5):897-901. [QxMD MEDLINE Link].

35. Liu JK, Couldwell WT. Pituitary apoplexy in the magnetic resonance imaging era: clinical significance of sphenoid sinus mucosal thickening. J Neurosurg. 2006 Jun. 104 (6):892-8. [QxMD MEDLINE Link].

36. Agrawal B, Dziurzynski K, Salamat MS, Baskaya M. The temporal association of sphenoid sinus mucosal thickening on MR imaging with pituitary apoplexy. Turk Neurosurg. 2012. 22 (6):785-90. [QxMD MEDLINE Link].

37. Vaphiades MS. Pituitary Ring Sign Plus Sphenoid Sinus Mucosal Thickening: Neuroimaging Signs of Pituitary Apoplexy. Neuroophthalmology. 2017 Dec. 41 (6):306-309. [QxMD MEDLINE Link].

38. Bills DC, Meyer FB, Laws ER Jr, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993 Oct. 33(4):602-8; discussion 608-9. [QxMD MEDLINE Link].

39. Kiyofuji S, Perry A, Graffeo CS, Giannini C, Link MJ. The dangers of the "Head Down" position in patients with untreated pituitary macroadenomas: case series and review of literature. Pituitary. 2018 Jun. 21 (3):231-237. [QxMD MEDLINE Link].

40. Thomason K, Macleod K, Eyres KS. Hyponatraemia after orthopaedic surgery - a case of pituitary apoplexy. Ann R Coll Surg Engl. 2009 Apr. 91(3):3-5. [QxMD MEDLINE Link].

41. Muthukumar N, Rossette D, Soundaram M, Senthilbabu S, Badrinarayanan T. Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci. 2008 Aug. 15(8):873-9. [QxMD MEDLINE Link].

42. Shepard MJ, Snyder MH, Soldozy S, Ampie LL, Morales-Valero SF, Jane JA. Radiological and clinical outcomes of pituitary apoplexy: comparison of conservative management versus early surgical intervention. Neurosurg. 2021 Apr 30. 1-9. [QxMD MEDLINE Link]. [Full Text].

43. Cavalli A, Martin A, Connolly DJ, Mirza S, Sinha S. Pituitary apoplexy: how to define safe boundaries of conservative management? Early and long-term outcomes from a single UK tertiary neurosurgical unit. Br J Neurosurg. 2021 Jun. 35(3):334-340. [QxMD MEDLINE Link]. [Full Text].

44. Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi J Anaesth. 2014. 8:335–341. [QxMD MEDLINE Link]. [Full Text].

45. Giritharan S, Gnanalingam K, Kearney T. Pituitary apoplexy – Bespoke patient management allows good clinical outcome. Clin Endocrinol. 2016. 85:415-422. [QxMD MEDLINE Link]. [Full Text].

46. Jho DH, Biller BMK, Agarwalla PK, Swearingen B. Pituitary apoplexy: Large surgical series with grading system. World Neurosurg. 2014. 82:781-790. [QxMD MEDLINE Link]. [Full Text].

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.

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.

Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, FRCSC Professor, Department of Ophthalmology and Vision Sciences, Sunnybrook Hospital, University of Toronto Faculty of Medicine; Incoming Chair of Ophthalmology, University of Alberta Faculty of Medicine and Dentistry, Canada

Edsel B Ing, MD, PhD, MBA, MEd, MPH, MA, 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, Canadian Medical Association, Canadian Ophthalmological Society, Canadian Society of Oculoplastic Surgery, Chinese Canadian Medical Society, European Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Statistical Society of Canada

Disclosure: Nothing to disclose.

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.

• Print this section
• Print the entire contents of
• Print the entire contents of article