Pituitary Apoplexy

Endocr Rev. 2015 Dec;36(6):622-45. doi: 10.1210/er.2015-1042. Epub 2015 Sep 28.


Pituitary apoplexy, a rare clinical syndrome secondary to abrupt hemorrhage or infarction, complicates 2%-12% of pituitary adenomas, especially nonfunctioning tumors. Headache of sudden and severe onset is the main symptom, sometimes associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Precipitating factors (increase in intracranial pressure, arterial hypertension, major surgery, anticoagulant therapy or dynamic testing, etc) may be identified. Corticotropic deficiency with adrenal insufficiency may be life threatening if left untreated. Computed tomography or magnetic resonance imaging confirms the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Formerly considered a neurosurgical emergency, pituitary apoplexy always used to be treated surgically. Nowadays, conservative management is increasingly used in selected patients (those without important visual acuity or field defects and with normal consciousness), because successive publications give converging evidence that a wait-and-see approach may also provide excellent outcomes in terms of oculomotor palsy, pituitary function and subsequent tumor growth. However, it must be kept in mind that studies comparing surgical approach and conservative management were retrospective and not controlled.

Publication types

  • Review

MeSH terms

  • Adrenocorticotropic Hormone / deficiency
  • Anticoagulants / adverse effects
  • Causality
  • Diabetes Insipidus
  • Diagnosis, Differential
  • Female
  • Headache
  • Hemorrhage
  • Humans
  • Hypertension
  • Intracranial Hypertension
  • Magnetic Resonance Imaging
  • Male
  • Necrosis
  • Pituitary Apoplexy* / diagnosis
  • Pituitary Apoplexy* / epidemiology
  • Pituitary Apoplexy* / therapy
  • Pituitary Gland / metabolism
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / pathology
  • Postoperative Complications
  • Risk Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vision Disorders


  • Anticoagulants
  • Adrenocorticotropic Hormone