Pituitary apoplexy history and symptoms: Difference between revisions
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==Overview== | ==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 disturbances, [[Nausea and vomiting|nausea and vomiting]]. | [[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 disturbances, [[Nausea and vomiting|nausea, and vomiting]]. | ||
==History== | ==History== | ||
Obtaining [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of pituitary apoplexy. | Obtaining a [[History and Physical examination|history]] gives important information in making a [[diagnosis]] of pituitary apoplexy. It provides 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]] | *[[Headache]] | ||
*Changes in [[vision]] or [[visual field]] | *Changes in [[vision]] or [[visual field]] | ||
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*[[Paralysis]] of the eye [[Muscle|muscles]] ([[ophthalmoplegia]]), causing double vision ([[diplopia]]). It can be due to [[intra]][[cavernous]] expansion of the [[tumor]] mass or a sudden increase in pressure in the [[pituitary]] region. | *[[Paralysis]] of the eye [[Muscle|muscles]] ([[ophthalmoplegia]]), causing double vision ([[diplopia]]). It can be due to [[intra]][[cavernous]] 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]]). | *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, [[ | *[[Extravasation]] of blood into [[subarachnoid space]] can lead to signs of [[meningeal irritation]] such as [[nausea]], [[vomiting]], [[photophobia]] and [[Meningismus|meningismus.]] | ||
*Low [[blood pressure]], [[nausea]], and [[vomit]]ing from [[acute adrenal insufficiency]]. | *Low [[blood pressure]], [[nausea]], and [[vomit]]ing from [[acute adrenal insufficiency]]. | ||
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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 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 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 fat in the abdomen
- Lack of energy
- Hypoadrenalism (if not already present or treated)
- Hypogonadism
- Absent periods (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.