Pituitary apoplexy history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pituitary apoplexy}} | {{Pituitary apoplexy}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Akshun}} | ||
==Overview== | |||
Pituitary apoplexy usually has a short period of [[symptoms]] ([[Acute (medicine)|acute]]), but it can be life-threatening. [[Symptoms]] usually include severe [[headache]], [[paralysis]] of [[eye muscles]], [[Visual disturbance|visual disturbances]], [[Nausea and vomiting|nausea, and vomiting]]. | |||
==History== | |||
Obtaining a [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of pituitary apoplexy. It provides an insight into the cause, precipitating factors, and associated [[comorbid]] conditions. A complete [[History and Physical examination|history]] will help determine the correct [[therapy]] and helps in determining the [[prognosis]]. Pituitary apoplexy patients may be [[Disorientation|disoriented]], therefore, the [[patient]] interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on onset, duration, and progression of [[symptoms]] such as: | |||
*[[Headache]] | |||
*Changes in [[vision]] or [[visual field]] | |||
*[[Ptosis]] | |||
*[[Medications]] | |||
*[[Symptoms]] of other [[organ failure]] ([[adrenal failure]]) | |||
*[[Comorbid|Co-morbid]] conditions like [[diabetes]], [[immunodeficiency]] | |||
==Symptoms== | ==Common Symptoms== | ||
Pituitary | Pituitary apoplexy usually has a short period of [[symptoms]] (acute), but it can be life-threatening. [[Symptoms]] usually include:<ref name="pmid28437813">{{cite journal |vauthors=Pyrgelis ES, Mavridis I, Meliou M |title=Presenting Symptoms of Pituitary Apoplexy |journal=J Neurol Surg A Cent Eur Neurosurg |volume= |issue= |pages= |year=2017 |pmid=28437813 |doi=10.1055/s-0037-1599051 |url=}}</ref><ref name="pmid10468988">{{cite journal| author=Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA| title=Classical pituitary apoplexy: clinical features, management and outcome. | journal=Clin Endocrinol (Oxf) | year= 1999 | volume= 51 | issue= 2 | pages= 181-8 | pmid=10468988 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10468988 }} </ref> | ||
*Severe [[headache]]: It is generally the first [[symptom]] to appear (seen in 80% of patients). | |||
*[[Paralysis]] of the eye [[Muscle|muscles]] ([[ophthalmoplegia]]), causing double vision ([[diplopia]]). It can be due to an intracavernous expansion of the [[tumor]] mass or a sudden increase in [[pressure]] in the [[pituitary]] region. | |||
*[[Visual disturbance|Visual disturbances]] from compression of surrounding structures ([[optic chiasm]] and [[optic tract]]). | |||
*[[Extravasation]] of [[blood]] into [[subarachnoid space]] can lead to signs of [[meningeal irritation]] such as [[nausea]], [[vomiting]], [[photophobia]], and [[Meningismus|meningismus.]] | |||
*[[Hypotension|Low blood pressure]], [[nausea]], and [[vomit]]ing from [[Acute (medicine)|acute]] [[adrenal insufficiency]]. | |||
Over time, problems with other [[Pituitary hormone|pituitary hormones]] may develop, causing [[symptoms]] of the following [[conditions]]: | |||
*[[Growth hormone]] deficiency | *[[Growth hormone]] deficiency | ||
**[[Fatigue]] | **[[Fatigue]] | ||
**Increased fat | **Increased [[Abdomen|abdominal]] [[fat]] | ||
**Lack of energy | **[[Lack of energy]] | ||
*[[Hypoadrenalism]] (if not already present or treated) | *[[Hypoadrenalism]] (if not already present or treated) | ||
**Inability to deal with physical stress | **Inability to deal with physical [[Stress (medicine)|stress]] | ||
**[[Nausea]] | **[[Nausea]] | ||
*[[Hypogonadism]] | *[[Hypogonadism]] | ||
** | **[[Amenorrhea]] in women | ||
**[[Sexual dysfunction]] and loss of muscle mass in men | **[[Sexual dysfunction]] and loss of [[muscle mass]] in men | ||
*[[Hypothyroidism]] | *[[Hypothyroidism]] | ||
**Cold intolerance | **Cold intolerance | ||
| Line 35: | Line 40: | ||
**[[Depressed mood]] | **[[Depressed mood]] | ||
**[[Dry skin]] | **[[Dry skin]] | ||
**[[Fatigue]] | **[[Fatigue]] | ||
* | **[[Hair]] or [[skin changes]] | ||
*[[ | |||
**[[Hoarseness]] | **[[Hoarseness]] | ||
**Menstrual changes | **[[Menstrual]] changes | ||
**Mental slowing | **Mental slowing | ||
**[[Weight gain]] | **[[Weight gain]] | ||
When the [[posterior pituitary]] is involved (rare), symptoms may include: | ==Less Common Symptoms== | ||
When the [[posterior pituitary]] is involved (rare), [[symptoms]] may include: | |||
*Failure of the [[uterus]] to contract as needed to give birth to a baby (in women) | *Failure of the [[uterus]] to contract as needed to give [[birth]] to a baby (in women) | ||
*Failure to produce breast milk (in women) | *Failure to produce [[breast milk]] (in women) | ||
*Uncontrolled urination | *Uncontrolled [[urination]] | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Medicine]] | |||
[[Category:Up-To-Date]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 16:23, 18 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
Pituitary apoplexy usually has a short period of symptoms (acute), but it can be life-threatening. Symptoms usually include severe headache, paralysis of eye muscles, visual disturbances, nausea, and vomiting.
History
Obtaining a history gives important information in making a diagnosis of pituitary apoplexy. It provides an insight into the cause, precipitating factors, and associated comorbid conditions. A complete history will help determine the correct therapy and helps in determining the prognosis. Pituitary apoplexy patients may be disoriented, therefore, the patient interview may be difficult. In such cases, history from the care givers or the family members may need to be obtained. The areas of focus should be on onset, duration, and progression of symptoms such as:
- Headache
- Changes in vision or visual field
- Ptosis
- Medications
- Symptoms of other organ failure (adrenal failure)
- Co-morbid conditions like diabetes, immunodeficiency
Common Symptoms
Pituitary apoplexy usually has a short period of symptoms (acute), but it can be life-threatening. Symptoms usually include:[1][2]
- Severe headache: It is generally the first symptom to appear (seen in 80% of patients).
- Paralysis of the eye muscles (ophthalmoplegia), causing double vision (diplopia). It can be due to an intracavernous expansion of the tumor mass or a sudden increase in pressure in the pituitary region.
- Visual disturbances from compression of surrounding structures (optic chiasm and optic tract).
- Extravasation of blood into subarachnoid space can lead to signs of meningeal irritation such as nausea, vomiting, photophobia, and meningismus.
- Low blood pressure, nausea, and vomiting from acute adrenal insufficiency.
Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions:
- Growth hormone deficiency
- Fatigue
- Increased abdominal fat
- Lack of energy
- Hypoadrenalism (if not already present or treated)
- Hypogonadism
- Amenorrhea in women
- Sexual dysfunction and loss of muscle mass in men
- Hypothyroidism
- Cold intolerance
- Constipation
- Depressed mood
- Dry skin
- Fatigue
- Hair or skin changes
- Hoarseness
- Menstrual changes
- Mental slowing
- Weight gain
Less Common Symptoms
When the posterior pituitary is involved (rare), symptoms may include:
- Failure of the uterus to contract as needed to give birth to a baby (in women)
- Failure to produce breast milk (in women)
- Uncontrolled urination
References
- ↑ Pyrgelis ES, Mavridis I, Meliou M (2017). "Presenting Symptoms of Pituitary Apoplexy". J Neurol Surg A Cent Eur Neurosurg. doi:10.1055/s-0037-1599051. PMID 28437813.
- ↑ Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999). "Classical pituitary apoplexy: clinical features, management and outcome". Clin Endocrinol (Oxf). 51 (2): 181–8. PMID 10468988.