Pituitary Apoplexy Treatment & Management

Updated: Apr 19, 2019
  • Author: Michael S Vaphiades, DO; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Treatment

Medical Care

The management of pituitary apoplexy is controversial in that some advocate early transsphenoidal surgical decompression in all patients, whereas others adopt a conservative approach for selected patients (without visual acuity or field defects and with normal consciousness). [24]

Medical treatment consists of the following:

  • Medically stabilize the patient.
  • Immediately evaluate electrolytes, glucose, and pituitary hormones.
  • Administer high-dose corticosteroids (most patients have hypopituitarism).
  • Administer appropriate endocrinologic replacement therapy alone or combined with transsphenoidal surgical decompression of the tumor.
  • Avoid the "head down" position, when possible. [37]
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Surgical Care

Evacuation of the tumor by a neurosurgeon should be planned once the patient is medically stable, especially in the setting of altered consciousness, visual acuity and, visual field loss. [38, 39, 24]

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Consultations

See the list below:

  • Neurosurgery for potential surgical therapy

  • Medicine for general medical management

  • Endocrinology for hormonal management

  • Ophthalmology for documentation of visual acuity, perimetry, and motility

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Further Inpatient Care

Monitor metabolic status, visual acuity, visual fields, and ocular motility.

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