Precipitating factors in pituitary apoplexy

Pituitary apoplexy is a rare but life threatening condition caused by sudde n haemorrhage or infarction of the pituitary gland. Potential precipitating factors in the occurrence of acute pituitary apoplexy in 30 consecutive pa tients were identified and compared with the clinical characteristics and o utcome of patients with and without associated factors. Six patients had a previously known pituitary adenoma. All patients complained of severe heada ches, associated with neuroophthalmological symptoms and signs in 83% and a ltered mental status in 30%. Potential risk factors were identified in nine patients (30%). When there was an associated factor, the clinical presenta tion was no different than in patients without such factors although altere d mental status may be more frequent in patients with associated diseases. In these patients, the visual prognosis was worse and the diagnosis was mor e difficult to establish. Acute pituitary apoplexy is unpredictable and sho uld be considered in any patient with abrupt neuro-ophthalmological deterio ration associated with headache. Patients with pituitary apoplexy often hav e an associated disease that confounds recognition and treatment despite a typical presentation.