for Endocrinology BES 2011
Pituitary apoplexy should be treated immediately by
specialist medical teams to avoid permanent damage to eye nerves and the nerves
controlling eye movement, according to new guidelines from the Society for
“The Society for Endocrinology wants to ensure that
all patients receive the safest and most effective treatment for pituitary
conditions,” John Wass, MA, MD, FRCP, chair of the Pituitary
Apoplexy Working Group, said in a press release. “Following a thorough
review of the literature, these guidelines aim to provide clinicians with
evidence-based information on the diagnosis and management of patients with
suspected pituitary apoplexy.”
These are the first guidelines in the United Kingdom to
specifically address the diagnosis and treatment of pituitary apoplexy, a
condition which, in the U.K., occurs at an estimated rate of 6.2 cases per
100,000 people, according to a press release. Symptoms include sudden onset
headache, nausea and vomiting, paralysis of some eye movements, visual
impairment and decreased consciousness.
The guidelines, which are endorsed by the Pituitary
Foundation, the Royal College of Physicians and the Society of British
Neurological Surgeons, were created based on a review of available literature.
Together, the working party held a multidisciplinary meeting and submitted its
guidelines to experts from a variety of disciplines, including endocrinology,
neurosurgery, ophthalmology and neuroradiology, for review.
The working group highlights the individual management
of patients based on history and symptoms, as well as the following:
- All patients presenting with acute severe headache, whether they
exhibit other symptoms, particularly if they have been previously diagnosed
with a pituitary tumor, should be evaluated for pituitary apoplexy.
- All patients with suspected pituitary apoplexy should undergo urgent
MRI, which provides a diagnosis in more than 90% of patients. If MRI is
contraindicated or not possible, CT scan should be used; however, they provide
a conclusive diagnosis in only 21% to 28% of cases.
- If acute secondary adrenal insufficiency is suspected, immediately
administer IV cortisol replacement in anticipation of the results of any
- All patients with suspected pituitary hormones should have urgent
blood samples taken to check their electrolytes and serum levels of pituitary
- Conservative management and surgical management are the two main
treatment options for pituitary apoplexy. The decision to choose one over the
other should be made by a multidisciplinary team of experts, including an
endocrinologist, neurosurgeon and ophthalmologist.
- Surgery should be conducted by an experienced pituitary surgeon,
rather than the on-call surgical team, unless immediate surgical intervention
- All patients with pituitary apoplexy require long-term management
based on the nature of the underlying pituitary tumor and the success of
treatment. All patients should have a full endocrine review at 4 to 8 weeks and
an MRI at 3 to 6 months after the event as part of standard management. Annual
clinical review in a joint endocrine/neurosurgical clinic is also recommended.
The group also suggests that further research on the
management of pituitary apoplexy be conducted to optimize treatment.
Disclosures: The members of the group report no relevant financial disclosures.
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