How a Pituitary Tumor May Cause a Severe Headache

Pituitary Tumor Apoplexy

How a Bleeding Tumor in the Pituitary Gland May Cause a Severe Headache
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Most headaches, while painful and disruptive to our lives, are not indicative of a more serious medical condition. In unusual circumstances, though, your headache may be the first sign that something dangerous is going on in the body. Pituitary tumor apoplexy is one example of a rare but potentially life-threatening condition that causes a severe, sudden headache.

Pituitary Basics

The "pituitary" part of this condition refers to the pituitary gland, an organ that sits at the base of the brain.

This gland is often referred to as the master gland because it releases a number of hormones into the body. Summarized below is a list of hormones made by the pituitary gland:

Thyroid-stimulating hormone ("TSH"): Stimulates the thyroid gland — located in the neck — to release hormones, which control how the body makes and uses energy.

Adrenocorticotropic hormone ("ACTH"): Stimulates the adrenal glands — allocated on top of the kidneys — to release the hormone cortisol, which controls how the body manages sugar levels and stress.

Luteinizing Hormone/Follicle-Stimulating Hormone: Stimulates the ovaries in a female to release estrogen and progesterone and the testicles in a male to release testosterone.


Prolactin: Stimulates milk production in lactating women.

Growth Hormone: Regulates growth and muscle/fat balance.

What is Pituitary Tumor Apoplexy?

In pituitary apoplexy, there is either bleeding into the pituitary gland or loss of blood supply to the gland.

In most, but not all cases of pituitary apoplexy, the patient already has a pituitary tumor. The tumor grows over the gland and often prevents the release of certain hormones, especially if the tumor is large. But sometimes a person does not know they have a tumor until apoplexy or bleeding into the gland occurs.

What Causes Pituitary Tumor Apoplexy?

According to a 2001 study at Emory University School of Medicine in the Journal of Neurology, Neurosurgery, and Psychiatry, factors that increase a person's chance of developing pituitary apoplexy include:

  • trauma
  • pregnancy
  • severe illness like a heart attack
  • severe infection

What are the Symptoms of Pituitary Tumor Apoplexy?

A person with pituitary tumor apoplexy usually has  a sudden-onset, severe headache at the front of the head and/or behind one or both eyes. A person may also have hormone deficiencies from the bleeding tumor, which affects the pituitary gland's ability to release hormones. For example, a person with pituitary apoplexy may have low blood pressure and low blood sugar from ACTH deficiency.

Other symptoms of pituitary tumor apoplexy may include:

• Nausea/vomiting

• Vision changes

• Fever

• Stiff neck

• Confusion

How is Pituitary Tumor Apoplexy Diagnosed and Managed?

Pituitary tumor apoplexy is a medical emergency and requires immediate imaging with either a computed tomography (CT) scan or magnetic resonance imaging (MRI) of the brain.

It can resemble other medical conditions listed below, so it's important to obtain a thorough evaluation by an emergency room doctor. Examples of other serious medical conditions that may cause a severe, sudden headache similar to pituitary tumor apoplexy include:

Subarachnoid Hemorrhage

Cerebral venous thrombosis

Meningitis/Encephalitis

Hypertensive Emergency

Cervical Artery Dissection

Once a person is diagnosed with pituitary tumor apoplexy, she will usually be given fluids and steroids through the vein, especially if ACTH deficiency is suspected. Then a person will be monitored closely in the hospital for any vision, neurological, or hormone changes. Sometimes brain surgery is needed to stabilize the bleeding and/or remove the tumor.

Long-term follow-up is important for people with pituitary tumor apoplexy. A person will commonly need to see a neurosurgeon and endocrinologist for repeat MRI imaging of the pituitary gland and regular hormone blood tests.

What Can I Do?

While this condition is rare and the vast majority of headaches do not have a worrisome cause, it's important that you are aware of your headache patterns, triggers, and course. If your headache has warning signs, it's critical to seek medical attention right away.

Sources
Agostoni E, Rigamonti A. Dangerous Headaches. Neurol Sci. 2008; 29:S107-9.

Biousse V, Newman N, Ovesiku N. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001;71(4):542-5.

Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med. 2008;23(2):75-90.

Ranabir S, Baruah MP. Pituitary apoplexy. Indian J Endocrinol Metab. 2011;15 Suppl 3:188-96.

Welt CK. Hypothalamic-pituitary axis. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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