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

Clinical Presentation of Pituitary Apoplexy

The signs and symptoms of pituitary apoplexy extend along a continuum from mild to life-threatening (ie, increased intracranial pressure). The most common complaint is sudden onset of severe headache, symptoms of meningeal irritation (neck pain and rigidity, photophobia), and acute visual field changes. Additional signs and symptoms include double vision (diplopia) or opthalmoplegia caused by cranial nerve palsies, vomiting, and changes in level of consciousness or loss of consciousness. The symptoms and presentation of pituitary apoplexy are often confused with those of subarachnoid hemorrhage, which can lead to further delays in definitive diagnosis. In addition, patients presenting with a decreased level of consciousness in a nonneuroscience care area may be evaluated for other etiologies before intracranial pathology is considered.

The presence of acute visual loss (commonly manifested as bitemporal hemianopia) and reductions in eye movements (from involvement of cranial nerves III, IV, and VI) assist in separating pituitary apoplexy from other intracranial processes. Because the pituitary gland is located close to the optic chiasm, acute visual loss is a classic symptom of both an enlarged pituitary gland and pituitary apoplexy. It is important to keep the possibility of intracranial pathology in the differential diagnosis, because an expeditious evaluation and intervention are essential for maximizing outcome and minimizing neurologic compromise.

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