Editor – I read with interest the excellent update on endocrine disease in pregnancy (Clin Med April 2013 pp179–81). I write to draw your attention to an often neglected pituitary emergency: pituitary apoplexy.
Pituitary apoplexy is a potentially life threatening medical emergency. Pregnancy is mentioned by Frise and Williamson as a possible cause of pituitary insufficiency. However, pregnancy and the immediate post-pregnancy period is a predisposing factor for pituitary apoplexy as a pre-existing pituitary adenoma may haemorrhage or infarct (eg, postpartum Sheehan's syndrome).
This would then lead to acute pituitary insufficiency requiiring immediate recognition of this presentation and urgent replacement with hydrocortisone and other pituitary hormones. Patients often present with headaches, vomiting, hypotension and can suffer with visual loss or ophtalmoplegia. It is recommended that patients are urgently referred to a joint pituitary (endocrine & neurosurgery) clinic.
I would be grateful if you could draw your readers attention to the national guidelines on pituitary apoplexy.1
References
- 1.Rajasekaran S, Vanderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf) 2011; 74:9–20. 10.1111/j.1365-2265.2010.03913.x [DOI] [PubMed] [Google Scholar]