Recognizing and Intervening in Pituitary Apoplexy

Elizabeth Zink, MS, ACNP, CCRN, CNRN

Disclosures

Topics in Advanced Practice Nursing eJournal. 2005;5(4) 

In This Article

Abstract and Introduction

Abstract

Pituitary apoplexy is a rare and life-threatening disorder often requiring emergency neurosurgical intervention to preserve vision and prevent cerebral herniation syndrome. Infarction or hemorrhage of an enlarged pituitary gland or pituitary tumor is the most common cause of pituitary apoplexy. Early recognition of this disorder is essential for preventing permanent visual loss or death; however, pituitary apoplexy often mimics subarachnoid hemorrhage, which in some cases may delay definitive diagnosis. Multidisciplinary evaluation of these patients will determine the most appropriate emergency treatment plan and long-term management strategies. Advanced practice nurses can be instrumental in recognizing signs and symptoms of pituitary apoplexy and coordinating the immediate and ongoing evaluation and care.

Introduction

Pituitary apoplexy is a rare and potentially life threatening disorder caused by primary hemorrhage, ischemic infarction, or hemorrhagic infarction of an enlarged pituitary gland or pituitary tumor. Patients with this disorder may present to the emergency department, outpatient clinic, or inpatient setting after an invasive procedure requiring general anesthesia, and they may or may not have a pre-established diagnosis of pituitary pathology. In some patients, pituitary apoplexy will be the first indication of a pituitary tumor.

The most common presenting signs of pituitary apoplexy are sudden onset of severe headache, visual changes, and cranial nerve palsies. Rapid assessment, diagnosis, and treatment of pituitary apoplexy will improve outcomes for this group of patients who initially may be misdiagnosed.

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