Pituitary apoplexy physical examination

Pituitary apoplexy Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Pituitary apoplexy from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X-ray
Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pituitary apoplexy physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Pituitary apoplexy physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pituitary apoplexy physical examination
CDC on Pituitary apoplexy physical examination
Pituitary apoplexy physical examination in the news
Blogs on Pituitary apoplexy physical examination
Directions to Hospitals Treating Pituitary apoplexy
Risk calculators and risk factors for Pituitary apoplexy physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.

Physical Examination

Vitals

• Low blood pressure

Skin

• Dry skin

Eye

• Visual acuity defects (52%) and visual field defects (64%) result from upward expansion of the tumor. Superior expansion of the tumor causes dysfunction of the optic nerve and optic chiasma. The most common visual field defect is a bitemporal superior quadrantic defect. Less commonly, optic tract involvement from a prefixed chiasm results in a contralateral homonymous hemianopia. Optic nerve compression from a postfixed chiasm is rare and may mimic optic neuritis with pain on eye movement, monocular visual acuity loss, and a central scotoma on visual field testing.
• Lateral expansion of the pituitary adenoma into the cavernous sinus is usually presented as compressive multiple cranial nerve palsies (nerves III, IV, V, and VI). If consciousness is maintained, diplopia may be present. Of the cranial nerves; 
  • Cranial nerve III (oculomotor nerve) is involved most commonly, resulting in a unilateral dilated pupil, ptosis, and eye that is deviated inferiorly and laterally.
  • Cranial nerve IV (trochlear nerve) palsy typically manifests as vertical diplopia, that worsens when the patient gazes in a direction opposite or tilts the head toward the direction of the affected eye.
  • Cranial nerve V (trigeminal nerve) involvement may produce facial pain or sensory loss.
  • Cranial nerve VI (abducent nerve) is least commonly involved, perhaps because of its sheltered position in the cavernous sinus. Its involvement produces horizontal diplopia, which results from inability to abduct the involved eye.
• Horner syndrome may develop from damage to the sympathetic fibers. Hemispheric deficits may also develop.

Extremities

• Atrophy of limbs

Neurologic

• Delayed reflexes