Extras

Question 2

What is pituitary apoplexy? [1]

Answer 2

Pituitary apoplexy
* Sudden enlargement of a pituitary tumour (usually non-functioning macroadenoma) secondary to haemorrhage or infarction.

Question 3

What are the precipitating factors [4] and features [+] of pituitary apoplexy

Answer 3

Precipitating factors
* hypertension
* pregnancy
* trauma
* anticoagulation

Features
* sudden onset headache similar to that seen in subarachnoid haemorrhage
* vomiting
* neck stiffness
* visual field defects: classically bitemporal superior quadrantic defect
* extraocular nerve palsies
* features of pituitary insufficiency
* e.g. hypotension/hyponatraemia secondary to hypoadrenalism

Question 4

Draw and name the vision loss seen in pituitary apoplexy [1]

Answer 4

visual field defects: classically bitemporal superior quadrantic defect

Question 5

Ix [1] and Mx [3] for pituitary apoplexy?

Answer 5

Investigation
* MRI is diagnostic

Management
* urgent steroid replacement due to loss of ACTH
* careful fluid balance
* surgery

Answer 6