Expansion
Sudden headache, visual loss and ophthalmoplegia with acute hypopituitarism
Expansion
Haemorrhage or infarction into a pituitary adenoma, presenting with:
- Sudden severe headache, often thunderclap, mimicking subarachnoid haemorrhage
- Visual field loss, classically bitemporal, from upward chiasmal compression
- Ophthalmoplegia, from lateral extension into the cavernous sinus affecting cranial nerves III, IV and VI. The third nerve is most often affected
- Reduced consciousness, meningism, vomiting
- Acute hypopituitarism, especially ACTH deficiency causing hypotension and hyponatraemia
Precipitants: hypertension, surgery, anticoagulation, dynamic pituitary testing, pregnancy, and dopamine agonist therapy.
Management: immediate hydrocortisone, urgent MRI, fluid and electrolyte correction, and neurosurgical decompression if there is visual or conscious level compromise. Milder cases can be managed conservatively.
Sheehan syndrome is the related obstetric condition: postpartum pituitary infarction after major haemorrhage, in a gland enlarged by pregnancy. It classically presents with failure of lactation and amenorrhoea, and may declare itself years later.