Pituitary infarction

• Alternative Names

  Pituitary apoplexy

• Causes, incidence, and risk factors

  Pituitary infarction is most commonly caused by bleeding due to a noncancerous tumor of the pituitary. When this bleeding occurs in a woman during or immediately after childbirth, it is called Sheehan syndrome.

  Risk factors for pituitary infarction include:

  • Bleeding disorders
  • Diabetes
  • Head injury
  • Radiation to the pituitary gland
  • Use of a breathing machine

  However, in most cases, the cause is not clear.

• Symptoms

  Pituitary infarction usually has a short period of symptoms (acute), but it can be life-threatening.

  Symptoms usually include:

  • Severe headache
  • Paralysis of the eye muscles, causing double vision (ophthalmoplegia)
  • Low blood pressure, nausea, and vomiting from acute adrenal insufficiency

  Less commonly, pituitary dysfunction may appear more slowly. In Sheehan syndrome, for example, the first symptom may be a failure to produce milk caused by a lack of the hormone prolactin.

  Over time, problems with other pituitary hormones may develop, causing symptoms of the following conditions:

  • Growth hormone deficiency
    • Fatigue
    • Increased fat in the abdomen
    • Lack of energy
  • Hypoadrenalism (if not already present or treated)
    • Inability to deal with physical stress
    • Nausea
  • Hypogonadism
    • Absent periods (amenorrhea) in women
    • Sexual dysfunction and loss of muscle mass in men
  • Hypothyroidism
    • Cold intolerance
    • Constipation
    • Depressed mood
    • Dry skin
    • Fatigue
    • Hair or skin changes
    • Hoarseness
    • Menstrual changes
    • Mental slowing
    • Weight gain

  When the posterior pituitary is involved (rare), symptoms may include:

  • Failure of the uterus to contract as needed to give birth to a baby (in women)
  • Failure to produce breast milk (in women)
  • Uncontrolled urination
• Signs and tests

  Signs of acute pituitary infarction may include:

  • Low blood pressure
  • Visual field defects

  Signs of chronic pituitary insufficiency include:

  • Growth hormone deficiency
    • Loss of muscle mass
    • Problems with fat metabolism (dyslipidemia)
  • Hypoadrenalism
    • Low blood pressure
    • Poor response to stress and infection
  • Hypothyroidism
    • Delayed reflexes

  Tests may include:

  • Bone density test
  • Eye exams
  • MRI or CT scan

  Blood tests will be done to check levels of:

  • ACTH
  • Cholesterol
  • Cortisol
  • FSH
  • Growth hormone
  • LH
  • Prolactin
  • Somatomedin C (IGF-1)
• Treatment

  Treatment for acute infarction may require surgery to relieve pressure on the pituitary and improve vision symptoms. Severe cases need emergency surgery.

  Immediate treatment with adrenal replacement hormones (glucocorticoids) is essential. Other hormones will be replaced, including:

  • Sex hormones (estrogen/testosterone)
  • Thyroid hormone

  Evidence is also growing for the need to replace growth hormone.

• Expectations (prognosis)

  Acute pituitary infarction can be life-threatening. The outlook is good for people who have chronic deficiency that is diagnosed and treated.

• Complications

  Complications of untreated pituitary infarction can include:

  • Adrenal crisis
  • Vision loss

  If other missing hormones are not replaced, you may develop problems related to hypothyroidism and hypogonadism.

• Calling your health care provider

  Call your health care provider if you have any symptoms of chronic pituitary insufficiency.

  Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of acute pituitary infarction, including:

  • Eye weakness
  • Headache
  • Low blood pressure (which can cause fainting)
  • Nausea
  • Vomiting

  Be especially concerned if you develop these symptoms and you have already been diagnosed with a pituitary tumor.

• References

  Melmed S, Kleinberg D. Anterior pituitary. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Saunders Elsevier; 2008:chap 8.

Review Date: 11/23/2009

Reviewed By: Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.