pituitary infarct

A pituitary infarct, also known as pituitary apoplexy, is a rare and serious condition that occurs when there's bleeding or loss of blood flow to the pituitary gland. This can cause a sudden and severe headache, vision problems, hormonal deficiencies, and other symptoms.

Causes:

• A pre-existing pituitary tumor (adenoma) can suddenly enlarge and bleed into the surrounding tissue, causing an infarct.
• Compression of the pituitary gland by a nearby tumor or cyst can also lead to loss of blood supply and infarction.

Symptoms:

• Sudden and severe headache
• Vision problems, including double vision or visual impairment
• Hormonal deficiencies, such as failure to produce breast milk in women or failure of the uterus to contract during childbirth
• Nausea and vomiting
• Paralysis or weakness affecting eye movements

Description:

A pituitary infarct is a sudden and severe attack that can cause significant damage to the pituitary gland. The compression or bleeding can lead to a loss of blood supply, causing tissue death and subsequent hormonal deficiencies.

Risk factors:

• Pre-existing pituitary tumor (adenoma)
• Compression by nearby tumors or cysts
• Sudden enlargement of a pre-existing tumor

Management:

Early recognition and treatment are crucial in managing pituitary infarct. This may involve hormone replacement therapy, surgery to remove the affected tissue, or other interventions to restore normal function.

References:

[4] Apoplexy means bleeding into an organ or loss of blood flow to an organ. Pituitary apoplexy is commonly caused by bleeding inside a noncancerous tumor (adenoma) in the pituitary gland. [7] The compression may also lead to a loss of blood supply (pituitary infarct), which can cause tumor cell death, bleeding and sudden tumor swelling. [8] Pituitary apoplexy is a potentially life-threatening endocrine disorder which may result from either from infarction or haemorrhage in the pituitary. [15] Pituitary haemorrhage and infarction are rare conditions. There are relatively few descriptions of large series to guide clinical management in the modern era (1, 13, 14, 15).

Symptoms of Pituitary Infarct

Pituitary infarct, also known as pituitary apoplexy, is a medical condition characterized by the sudden loss of blood flow to the pituitary gland. This can lead to a range of symptoms, including:

• Sudden and severe headache: This is often the most common initial symptom, caused by the increased pressure in the space surrounding the pituitary gland [1].
• Visual disturbances: Compression of the optic nerves or chiasm can cause visual impairment, including double vision, blurred vision, or loss of vision [2][3].
• Altered mental status: Changes in hormonal function due to the sudden interruption of hormone release can lead to altered consciousness, confusion, and decreased mental function [4].
• Hormonal dysfunction: The sudden interruption of hormone release can cause a range of symptoms, including changes in appetite, weight loss or gain, fatigue, decreased energy, and dizziness [5][6].
• Low blood pressure: Acute adrenal insufficiency can lead to low blood pressure, which can cause fainting [7].

Other Symptoms

In some cases, pituitary infarct may also be associated with:

• Nausea and vomiting
• Eye muscle weakness or vision loss
• Loss of appetite
• Weight loss or gain
• Fatigue
• Decreased energy
• Decreased mental function
• Dizziness

It's essential to seek immediate medical attention if you experience any of these symptoms, as pituitary infarct can be life-threatening and requires urgent treatment.

References:

[1] Context 1 [2] Context 5 [3] Context 7 [4] Context 11 [5] Context 6 [6] Context 8 [7] Context 9

Diagnostic Tests for Pituitary Infarct (Apoplexy)

Pituitary infarct, also known as pituitary apoplexy, is a medical emergency that requires prompt diagnosis and treatment. The following diagnostic tests are commonly used to diagnose pituitary infarct:

• Imaging tests: Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) are the primary imaging modalities used to evaluate the pituitary gland. CT scanning is generally the initial imaging study of choice in the emergency setting, while MRI provides more detailed images of the pituitary gland.
• Hormone testing: Blood tests may be ordered to assess hormone levels, including:
  • ACTH (adrenocorticotropic hormone)
  • Cortisol
  • FSH (follicle-stimulating hormone)
  • Growth hormone
  • LH (luteinizing hormone)
• Electrolyte and blood count tests: These tests may be ordered to assess electrolyte levels, complete blood count, and prothrombin time.
• Visual testing: Visual field defects or other visual disturbances may be assessed as part of the diagnostic evaluation.

Key Findings

The following key findings are commonly associated with pituitary infarct:

• Hemorrhagic infarct in the region of the pituitary gland: This is a characteristic finding on MRI.
• Hyponatremia: Low sodium levels may be present.
• Anemia and thrombocytopenia: Abnormal blood counts may be observed.
• Prolonged prothrombin time: This may indicate coagulopathy.

References

[4] CT scanning generally is the initial imaging study of choice in the emergency setting. [7] The best tools for diagnosing PA are computed tomography (CT) and MRI. [9] The most commonly used imaging modality for the diagnosis of PA is MRI as it is very sensitive in detecting hemorrhage and infarction within the pituitary gland. [12] Table 3. Useful Tests in the Diagnosis of Pituitary Apoplexy; Prothrombin time, Possibly prolonged; FT4/TSH, Low/Low or normal; Prolactin, Low (< 1 ng/dl).

Treatment Options for Pituitary Infarct

Pituitary infarct, also known as pituitary apoplexy, is a serious condition that requires prompt medical attention. The primary goal of treatment is to stabilize the patient and prevent further complications.

• High-dose corticosteroids: Administering high doses of corticosteroids, such as hydrocortisone, is crucial in treating pituitary infarct [2]. This helps to replace the deficient cortisol levels and prevent adrenal crisis.
• Endocrinologic replacement therapy: Patients with hypopituitarism may require replacement therapy for other hormones, such as thyroid hormone, sex hormones, or growth hormone [3].
• Fluid and electrolyte management: Careful monitoring of fluid and electrolyte levels is essential to prevent dehydration and electrolyte imbalances [7].

Other Treatment Considerations

While the primary treatment focuses on stabilizing the patient and replacing deficient hormones, other factors may also be considered:

• Surgery: In some cases, surgery may be necessary to relieve pressure on the optic chiasm or to remove a pituitary tumor [9].
• Radiation therapy: This may be an option for patients with a pituitary tumor that cannot be removed surgically [9].

Important Notes

It is essential to note that treatment should only be initiated by a qualified healthcare professional, and the specific treatment plan will depend on individual patient needs. Additionally, prompt medical attention is crucial in preventing long-term complications and improving outcomes.

References:

[1] SE Baldeweg (2016) - Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone may be lifesaving. [2] Oct 21, 2024 - Administer high-dose corticosteroids (most patients have hypopituitarism). Administer appropriate endocrinologic replacement therapy alone or ... [3] by H Ghadirian · 2018 · Cited by 20 — Although pituitary apoplexy is usually spontaneous, one of the predisposing factors is treatment with dopamine agonists, especially bromocriptine. [7] Pituitary Apoplexy: Treatment Options · Rapid replacement with hydrocortisone may be lifesaving.

The differential diagnosis for pituitary infarct, also known as pituitary apoplexy, includes several conditions that can present with similar symptoms.

• Adrenal crisis: This is a life-threatening condition that occurs when the adrenal glands do not produce enough cortisol and aldosterone hormones. It can cause symptoms such as severe headache, vomiting, and altered mental status [1][2].
• Subarachnoid hemorrhage: This is a type of bleeding in the brain that can cause sudden onset of severe headache, vomiting, and altered mental status [3][4].
• Meningitis: This is an infection of the meninges, the protective membranes surrounding the brain and spinal cord. It can cause symptoms such as fever, headache, and altered mental status [5][6].
• Craniopharyngioma: This is a type of tumor that occurs in the pituitary gland region and can cause symptoms such as headache, visual disturbances, and altered mental status [7][8].
• Rathke cleft cyst: This is a type of fluid-filled lesion that occurs in the sella turcica, the bony structure that houses the pituitary gland. It can cause symptoms such as headache, visual disturbances, and altered mental status [9][10].

These conditions should be considered in the differential diagnosis for pituitary infarct, especially when evaluating patients with sudden onset of severe headache, vomiting, and altered mental status.

References:

[1] Beatriz Lecumberri, María Ángeles Gálvez, Clinical practice guideline for the diagnosis and treatment of pituitary apoplexy, Endocrinología y ..., [2] [3] Oct 13, 2024 — Differential diagnosis ; adamantinomatous craniopharyngioma. calcification in 90%. usually in children. usually not acute presentation ; Rathke ..., [4] [5] Apr 22, 2018 — The differential diagnosis of pituitary apoplexy should include other conditions that result in the symptoms of headache, vomiting, and altered mental status., [6] [7] Oct 13, 2024 — Differential diagnosis ; adamantinomatous craniopharyngioma. calcification in 90%. usually in children. usually not acute presentation ; Rathke ..., [8] [9] MRI is a useful tool in the differential diagnosis of pituitary apoplexy. ... MRI can evaluate pituitary infarct and haemorrhage, mass effect and differentiate PA from other pathologies such as a Rathke cleft cyst or craniopharingioma., [10] [11] Asymptomatic hemorrhage and infarct into a pituitary tumor can occur in 10-25% of patients, however true apoplexy (the constellation of symptoms noted above) occurs in 2-10% of pituitary tumor patients. ... The differential diagnosis of pituitary apoplexy should include other conditions that result in the symptoms of headache, ..., [12] [13] Formulating a differential diagnosis of a lesion in this region relies heavily on neuroimaging in addition to clinical and laboratory data. ... T2-weighted gradient-echo MRI is very sensitive in detecting the presence of past hemorrhage., [14]