What is pituitary apoplexy?
What are the clinical signs and manifestations of pituitary apoplexy?
How is pituitary apoplexy diagnosed?
How is pituitary bleeding treated with pituitary plexus?
If you or those around you have this complication and you want to get research information about it, we recommend that you read more.
Introduction: Pituitary apoplexy
One of the most important endocrine glands in the body is the pituitary gland. It is located in the lower part of the brain and in the cavity of the butterfly bone.
The pituitary gland makes vital hormones, and many of our body’s vital functions are regulated by these hormones.
Bleeding inside the pituitary gland occurs due to a problem in this gland and we must say that pituitary apoplexy or bleeding pituitary gland is an emergency problem.
If pituitary apoplexy is not managed and treated urgently, it can lead to serious complications, such as hypotension, central nervous system hemorrhage, dangerous glucose depletion, and even death. In this article, we want to talk more about pituitary apoplexy or bleeding inside the pituitary gland and the causes of bleeding and its signs and symptoms and diagnostic solutions.
Familiarity with the pituitary gland
To better understand pituitary apoplexy and its complications, it is better to get acquainted with the pituitary gland and its functions. One of the main endocrine glands in the body, the hormones secreted by which control the vital functions of many organs, is the pituitary gland.
Among the hormones secreted by the pituitary gland, we mention the following and explain a little about its function.
- Growth Hormone
The longitudinal and transverse growth of our body bones depends on this hormone. Our height increase depends on the presence of growth hormone secreted by the pituitary gland. Also, the increase in the metabolism of our body cells is balanced by this hormone.
Prolactin is a hormone that regulates breast growth and postpartum milk secretion during pregnancy.
- Corticotropin Hormone
The presence of this stimulating hormone is necessary for the secretion of cortisol from the adrenal glands.
- LH and FSH hormones
These two hormones are very effective in the growth, development and maturation of the sexual organs.
Thyroid stimulating hormone is secreted by the pituitary gland and it stimulates the thyroid cells that secrete thyroid hormone.
It is one of the internal soothing hormones of the body.
- Melanocyte Stimulating Hormone
This hormone will work when your skin is exposed to ultraviolet rays. It stimulates skin pigments by stimulating the skin with ultraviolet rays.
What are the types of pituitary disorders?
You have seen that very vital hormones are secreted form the pituitary. so any disturbance in the activity of the pituitary gland, will cause an increase or decrease in the amount of the above hormones, and there will be problems.
Here are some of these problems:
- Pituitary tumors
- Pituitary damage following brain trauma
- Central diabetes insipidus (CDI)
- Pituitary hypofunction
- Cushing’s syndrome
- Pituitary apoplexy or bleeding pituitary gland
Pituitary gland bleeding, pituitary apoplexy?
One of the disorders and problems that can occur in the pituitary gland and is actually considered an emergency is pituitary apoplexy.
This means that when the pituitary gland bleeds on the inside, this condition will put the patient in a completely emergency situation. The person must be taken to the emergency room immediately. Bleeding from the pituitary gland will be a very dangerous and sometimes life-threatening condition.
What are the symptoms of pituitary apoplexy?
It is a very urgent condition that can lead a person even to death, and although the pituitary gland is small in size, but the activity of this gland has a great impact on controlling vital functions of the body. The most common symptom of pituitary bleeding is very severe and sudden headaches in addition to vision problems on both sides. signs and symptoms of pituitary plexus include:
Nausea and vomiting, Severe and sudden headaches behind the eyes and around the temples.
Sudden and very severe headaches, mainly behind the eyes and around the temples, Stiff neck, Nausea and vomiting, decreased level of consciousness, Decreased visual acuity, Light intolerance, limited field of vision and blindness, complete diplopia, dilated pupils, weakness and numbness of one half of the body, Intracranial hemorrhage, including intracerebral hemorrhage, Stroke, Severe hypoglycemia, which can lead to dehydration, Abdominal pain, Adrenal crisis and Addison’s crisis, Severe decrease in blood sodium concentration, decreased cortisol hormone, Decreased adh hormone, decreased Thyroid gland activity, ovarian failure in women and testicular failure in men, Infertility in both men and women, interruption in the menstrual cycle in women and Disruption of the female menstrual cycle.
- Bilateral visual impairment
One of the complications that will be caused by the pituitary gland problem is low vision and blindness, i.e the affected person has problems in his vision and the interesting point is that this condition will occur in both eyes.
Ophthalmoplegia’s ocular paralysis, which occurs as a result of involvement of a number of eye muscles, is also possible due to pituitary gland damage, including bleeding inside the pituitary gland. Muscles lose control and will not be able to keep the eye normal and even the elements of the eye may move out of their natural places.
- Cardiovascular collapse
In fact, due to intra-pituitary hemorrhage due to a series of changes in the cardiovascular system, the body’s arteries and blood vessels dilate, thus not being able to store blood and deliver blood to vital organs. These conditions are called cardiovascular collapse. A drop in blood pressure in these people can even lead to death.
- Symptoms of meningeal stiff neck and positive Kernig and Brudzinski tests may cause intra-pituitary bleeding
One of the symptoms and manifestations in people with pituitary apoplexy is Decreased level of consciousness. Decreased level of consciousness is one of the symptoms of brain diseases. Unfortunately, in this situation, a person may reach a state where he does not respond to any stimulus.
What causes pituitary apoplexy or bleeding inside the pituitary gland?
The most common cause of bleeding inside the pituitary gland is said to be bleeding inside a benign tumor that was inside the pituitary gland or dead tissue that was the result of the tumor’s growth, and bleeding inside these dead tissues. In some cases, patients only notice the onset of these intra-pituitary tumors when pituitary apoplexy has occurred. Other causes that increase the risk of pituitary apoplexy include:
Hypertension in People who have had pituitary radiotherapy, Pregnant women after major surgery such as open-heart surgery, Trauma and head and neck injury, use of anticoagulants, Sudden and prolonged severe hypotension in women receiving estrogen therapy, treatment with prolactin antagonist in people with prolactinoma.
Another predisposing factor for pituitary plexus is the recent Dynamic function tests (DFT’s).
A person who presents with symptoms and manifestations of pituitary gland bleeding, in addition to the history of the symptoms, a complete medical and neurological examination should be performed and the doctor should order an examination of the hospital, because This is a very serious life-threatening and emergency condition. The first step in diagnosing an accurate and complete interview is to take notes and note the symptoms.
The best paraclinical and diagnostic tool and method is MRI of the head and neck. With MRI of the head and neck, 90% of patients with pituitary apoplexy are given a definitive diagnosis. With a CT scan of only 21-28%, the correct diagnosis of apoplexy may be made.
In addition to paraclinical management, radiology, blood tests, and hormone tests are performed to determine which part of the patient’s pituitary gland is damaged.
It is said that 80% of patients who have pituitary apoplexy, will have problems with one or more pituitary hormones. Also, if there are vision problems, a vision examination should be performed to measure the visual acuity of the field and the accuracy of the vision.
Once the definitive diagnosis is made and treatment is started quickly, Among the treatment approaches, we mention the main ones:
- The first approach is to inject a high dose of corticosteroids quickly
plus, the patient’s blood electrolyte levels as well as body fluids should be closely monitored.
Pituitary surgery If there is extensive bleeding or if there is a bleeding pituitary adenoma, must be performed sometimes.
Surgery is optionally performed through a nasal endoscopy called EEE, which is a minimally invasive surgery.
A thin tube enters through the nasal cavity By making a hole at the end of the nasal canal that is about 5 mm in diameter, and is directed into the brain and pituitary gland.
This surgery is performed very quickly. The incisions are small. The recovery period is much shorter and the patient will be in the hospital for a short time. After treatment for pituitary apoplexy, we must see rapid improvement in vision. In some cases, damage to the pituitary gland may have caused hormonal problems.
Some cases of hormonal problems after surgery require the administration of special drugs to balance the changed condition.
When treating pituitary hemorrhage, several steps are required to follow up:
Hormone testing should be done one to two months after the initial treatment, and another MRI should be done three to six months after the treatment.