Emergency and Nursing Management of Pituitary Apoplexy-An Updated Review

Hail Marran Jabban Alanazi; Zayed Aied Fadgash Almaradhi; Saad Salamah Salem Al-Fuhaigi; Mansour Salem Qadhib Alanazi; Jazzaa Otayban Huran Alruwaili; Abdullah Mohammed Abdullah Alowaydhah; Ahmed Munahi Jadid Alruwily; Abdulrahman Shaker Alruwily; Atiah Zaydi M Alruwaili; Ahmed Qalil Shihab Alruwaili; Majed Hamed Majed Alshammari; Tawfiq Atallah Saad Alrashed; Madallah Mahja Al-Sharari; Tawfiq Sultan Jahbal Alsaadi

doi:10.64483/202412534

Hail Marran Jabban Alanazi ⁽¹⁾, Zayed Aied Fadgash Almaradhi ⁽¹⁾, Saad Salamah Salem Al-Fuhaigi ⁽²⁾, Mansour Salem Qadhib Alanazi ⁽¹⁾, Jazzaa Otayban Huran Alruwaili ⁽¹⁾, Abdullah Mohammed Abdullah Alowaydhah ⁽¹⁾, Ahmed Munahi Jadid Alruwily ⁽¹⁾, Abdulrahman Shaker Alruwily ⁽¹⁾, Atiah Zaydi M Alruwaili ⁽¹⁾, Ahmed Qalil Shihab Alruwaili ⁽¹⁾, Majed Hamed Majed Alshammari ⁽³⁾, Tawfiq Atallah Saad Alrashed ⁽¹⁾, Madallah Mahja Al-Sharari ⁽¹⁾, Tawfiq Sultan Jahbal Alsaadi ⁽¹⁾

(1) Branch of the Ministry of Health in Al-Jouf, Saudi Arabia,

(2) Al-Jouf Health Emergency and Disaster Management Center,Ministry of Health, Saudi Arabia,

(3) Al-Jouf Health Cluster,Ministry of Health, Saudi Arabia

https://doi.org/10.64483/202412534

Issue
Vol. 1 No. 2 (2024)

Submitted
January 18, 2026

Published
December 31, 2024

Keywords:

Pituitary apoplexy, pituitary adenoma, adrenal insufficiency, emergency management, transsphenoidal surgery.

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Abstract

Background: Pituitary apoplexy is a rare but potentially life-threatening endocrine and neurological emergency caused by acute hemorrhage or ischemic infarction of the pituitary gland, most commonly within a preexisting adenoma. It presents abruptly with severe headache, visual impairment, ophthalmoplegia, and acute hormonal deficiencies, particularly adrenal insufficiency.

Aim: This review aims to summarize current evidence regarding the etiology, pathophysiology, clinical presentation, diagnostic evaluation, and contemporary management strategies of pituitary apoplexy, with emphasis on emergency and nursing considerations.

Methods: A narrative review approach was employed, synthesizing published clinical studies, imaging data, and management guidelines related to pituitary apoplexy. Emphasis was placed on acute presentation, diagnostic imaging, endocrine assessment, and outcomes of medical versus surgical management.

Results: Pituitary apoplexy most frequently occurs in patients with previously unrecognized pituitary macroadenomas. Magnetic resonance imaging is the diagnostic modality of choice, while laboratory evaluation commonly reveals multiple hormonal deficiencies. Immediate corticosteroid therapy is essential and lifesaving. Surgical decompression is indicated in patients with visual deterioration or reduced consciousness, whereas conservative management is appropriate in selected stable cases.

Conclusion: Early recognition, prompt steroid replacement, appropriate imaging, and multidisciplinary management are critical to reducing morbidity and mortality associated with pituitary apoplexy.

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