Pituitary Infarction and Apoplexy: The Need for Early Recognition in Intensive Care Units

Pituitary infarction can occur after prolonged shock, usually from peripartum hemorrhage. With good obstetrical care and prompt transfusion therapy, it is largely preventable. Spontaneous pituitary infarction is much less common. It can be recognized in diabetic patients by the sudden appearance of a severe, usually retroorbital, headache and frequent episodes of hypoglycemia from an abrupt decrease in insulin requirement. When hemorrhage occurs with a pituitary tumor of sufficient expansion to produce acute parasellar manifestations, it is called pituitary apoplexy. Many patients, particularly men, are unaware of a preexisting pituitary tumor, but some will have features of acromegaly and others will have a history of sexual dysfunction. In the more severe cases, early diagnosis is imperative so that prompt neurosurgical evacuation can be undertaken.