A Case of Pituitary Apoplexy Complicating the Management of Sepsis

Pituitary apoplexy is a condition of sudden hemorrhage into the pituitary gland, usually at the site of a pituitary adenoma, occurring in 8% of pituitary macroadenomas. The clinical presentation of pituitary apoplexy varies based upon the timing and mechanism of pituitary mass expansion towards the optic nerve or hypothalamus, as well as the hormonal function of the neoplasm and remaining pituitary gland tissue. Nearly all patients present with headache (97%), and fewer patients present with visual field impairment (71%). Pituitary apoplexy acutely disrupts the hypothalamic-pituitary-adrenal (HPA) axis, and may lead to relative adrenal insufficiency in septic shock, with a high mortality if not recognized and treated.