Sandbox:Akshun

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 must be differentiated from other diseases that cause severe headache such as subarachnoid hemorrhage, meningitis, cerebral hemorrhage, intracranial mass, infarction, intracranial venous thrombosis, migraine, cavernous sinus thrombosis, cerebellar hemorrhage, midbrain infarction.

Differentiating Pituitary apoplexy From Other Diseases

Pituitary apoplexy should be differentiated from other diseases causing severe headache for example

Disease	Symptoms
Severe headache with or without changes in mental status
Subarachnoid hemorrhage	Severe headache (as a worst headache of the life) Headache is the main symptom (often starts suddenly and starts after a popping or snapping feeling in the head) Double vision Nausea and vomiting Symptoms of meningeal irritation Nuchal rigidity and pain Back pain Bilateral leg pain Numbness Weakness Sudden decreased level of consciousness Rapid progression of symptoms Speech disturbance
Meningitis	Fever,  neck stiffness headache. Other symptoms include, photophobia (inability to tolerate bright light), phonophobia (inability to tolerate loud noises), irritability, altered mental status (in small children), and seizure.
Intracranial Mass	Headache Nausea Vomiting Change in mental status Seizures Focal symptoms of brain damage Associated co-morbid conditions like tuberculosis, etc
Cerebral hemorrhage	Increased intracranial pressure (ICP) (headache, vomiting, and depressed level of consciousness)  progression of focal neurological deficits over periods of hours
Infarction
Intracranial venous thrombosis
Severe headache with decreased visual acuity, ocular palsies, or visual field changes
Complicated migraine
Midbrain infarction
Cavernous sinus thrombosis
Cerebellar hemorrhage
Signs of hypopituitarism (hypogonadism, hypoadrenalism, or hypothyroidism)
Head injury
Lymphocytic hypophysitis
Iatrogenic surgical
Radiation injury
Infections (particularly tuberculosis and mycotic infections)