Apoplexy is a medical term which refers to cerebral hemorrhage or other sudden neurological impairment.
The word “apoplexy” originates from the Greek “apoplexia” and translates as ”a seizure,” in the sense of being struck down. This word was occasionally used to refer to the symptom of sudden loss of consciousness immediately preceding death.
The term ”pituitary apoplexy” was first used in 1950 by Brougham et al. when describing 5 cases of this clinical entity.
Pituitary apoplexy (PA) is a rare endocrine emergency that can occur due to infarction or hemorrhage of the pituitary gland, a small gland joined to the hypothalamus (part of the brain which contains small nuclei with various functions).
The pituitary gland is connected to the hypothalamus by the pituitary stalk and sits in a small pocket of bone (called the sella turcica) in the base of the skull.
PA may have a variable clinical presentation but should be suspected in any individual with visual deficits, severe headache, altered mental status, or ophthalmoplegia.
It is essential to note that PA may be divided into ischemic or hemorrhagic, each with unique neuroimaging findings. Also, when this condition occurs in a woman during or right after childbirth, it is called Sheehan syndrome.
Pregnancy is a risk factor for this condition, most likely due to increased pituitary blood flow induced by estrogens as well as to an increased pituitary volume secondary to lactotroph hyperplasia, that returns to normal 6 months post-partum.
This condition is rare, with an incidence of 0.17 episodes in 100,000 persons per year and an estimated prevalence of 6.2 cases per 100,000 inhabitants. It is more common in males, with a gender ratio of 2:1 and a mean age of onset of 57 years.
- Personality changes because of sudden narrowing of one of the arteries in the brain;
- Nausea, low blood pressure, vomiting, and loss of appetite, from acute adrenal insufficiency;
- Paralysis of the eye muscles, causing problems opening an eyelid or double vision (ophthalmoplegia);
- A severe headache.
PA is caused either by the death of an area of tissue or a hemorrhage in the pituitary gland, commonly in association with the presence of a pituitary tumor.
It tends to happen most frequently in large tumors, macroadenomas. In addition, PA occasionally occurs as a result of bleeding into a normal pituitary gland; this usually occurs in people who have type 2 diabetes mellitus.
Other risk factors of PA include – sickle cell anemia, pregnancy, dopamine agonist therapy, estrogen replacement, head trauma, and lymphocytic leukemia.
Pituitary Apoplexy – Spiritual Meaning
During an apoplexy attack, the irrigation of certain areas of the brain is interrupted and they cease to function properly. It proves an extreme resistance to life and a denial of the Ego at the same time.
This leads to paralysis which restricts your activity in the outside world. Understand this lesson, develop and pay more attention to your feelings and intuition. Accept life as a whole.
Your healthcare specialist may order imaging tests, like a CT scan or an MRI. Moreover, he will check your hormone levels, as well as your electrolyte and blood sugar levels.
Standard treatment of PA includes:
- immediate initiation of high-dose steroid treatment that can improve symptoms of this condition, occasionally in as little as a few days;
- surgical decompression, commonly via a transsphenoidal route, if symptoms are considered “rapidly progressive” or “severe.”
Unless immediate surgical intervention is needed, surgery should be conducted by an experienced pituitary surgeon. Also, it is crucial to note that endocrinological follow-up after this complicated surgery is required since many sufferers need a hormonal replacement for a long-term basis.