What are the potential complications of pituitary apoplexy that I should monitor for in the acute management phase?

Potential complications of pituitary apoplexy to monitor during the acute management phase include:

• Hypopituitarism: This can manifest as deficiencies in multiple pituitary hormones leading to adrenal insufficiency (adrenocorticotropic hormone deficiency), hypothyroidism (thyroid-stimulating hormone deficiency), growth hormone deficiency, sex hormone deficiencies, and vasopressin deficiency causing diabetes insipidus symptoms such as polyuria and polydipsia.
• Adrenal insufficiency: Presents with weakness, fatigue, hypotension, hyponatraemia, and hypoglycaemia, which can be life-threatening if not promptly treated.
• Visual disturbances: Due to compression of the optic chiasm or nerves, patients may experience visual field defects or decreased visual acuity.
• Neurological deterioration: Including altered consciousness and focal neurological deficits, requiring close neurological observation using Glasgow Coma Scale and pupil reactivity assessments.
• Electrolyte imbalances: Such as hyponatraemia, which may indicate syndrome of inappropriate antidiuretic hormone secretion or adrenal insufficiency.
• Hydrocephalus or raised intracranial pressure: Though less common, these may occur secondary to hemorrhage or edema and require urgent neuroimaging and management.

Close monitoring of vital signs, neurological status, fluid balance, and endocrine function is essential during the acute phase to detect and manage these complications promptly.

These recommendations align with the NICE guidance on head injury and hypopituitarism, emphasizing the importance of monitoring for hypopituitarism symptoms and neurological deterioration after brain injury events such as pituitary apoplexy ¹.