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Hemorrhage into a Pituitary Tumor 

Hemorrhage into a Pituitary Tumor
Hemorrhage into a Pituitary Tumor
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


Hemorrhage into a pituitary tumor is a rare potential medical emergency. Pituitary apoplexy should be suspected in a patient with sudden headache, oculomotor palsy, and sellar mass. This chapter presents the approach to stabilizing the patient and interpreting laboratory and imaging abnormalities. MRI is twice as sensitive as CT to detect hemorrhage in pituitary tumors and is the neuroimaging modality of choice. Acute medical care consists of stabilizing physiology with corticosteroid replacement and management of electrolyte and fluid derangements. The indications for urgent neurosurgical management are also presented. Transsphenoidal resection is the mainstay of definitive treatment and should be urgently performed for patients with a depressed level of consciousness or acute neuroophthalmic deficits.

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