What Causes Pituitary Apoplexy?

Major Surgery

Any major surgical procedure can cause pituitary apoplexy due to surgical stress. Surgical stress describes when the injuries incurred to the patient's tissues during surgery can cause their sympathetic nervous system to become activated. The activation of the sympathetic nervous system produces hematological changes, immunological changes, and endocrine responses. These endocrine responses include an abnormal stimulation of the patient's pituitary gland that puts it under extreme pressure to produce excess amounts of steroids. In most surgical environments, surgical stress is well managed by the anesthesiologist and surgical team, but this management is not always effective for each patient. Other surgical procedures can also produce pituitary apoplexy through different mechanisms that are the result of changes in the patient's blood pressure and intracranial pressure. These changes can produce a bleed that precipitates pituitary apoplexy. Such procedures include angiography, myelography, spinal anesthesia, pneumoencephalography, and lumbar puncture.

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Certain Medications

Pituitary apoplexy can be induced due to certain medications as an adverse but severe side effect. Medications that increase the risk of bleeding excessively that are taken for frequent blood clots, hypercoagulability, heart disease, heart defects, high blood pressure, previous stroke, and high risk of stroke can also cause a bleed in the pituitary gland and neighboring tissues. These medications include anticoagulants, antithrombotic drugs, and thrombolytic agents. Medications that cause an individual to have elevated estrogen such as birth control and medications for post-menopausal women can cause sudden changes in the pituitary gland tissue that may result in pituitary apoplexy. Certain medications that may be used when a patient undergoes a form of diagnostic testing referred to as dynamic pituitary gland testing can cause an overload of the pituitary gland. The medications known to produce this stressful condition that leads to pituitary apoplexy include thyrotropin-releasing hormone, bromocriptine, and gonadotropin-releasing hormone.

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