Hormonal syndromes associated with hypersecretion of a particular pituitary hormone Local mass effect on the pituitary and surrounding structures acutely with pituitary apoplexy , a generally catostrophic event which really gets the patient's attention. Hormonal syndromes are becoming better recognized clinically and more easily detected due to increasingly sensitive laboratory tests. Tumors which present this way are commonly nonsecreting tumors and prolactinomas in older men.
People presenting with apoplexy are sick.
The sudden doubling or tripling of the pituitary tumor's volume impinges on its surrounding structures and causes the characteristic findings of pituitary apoplexy. Sudden pressure on the optic nerves causes decreased vision, up to total blindness. Sudden pressure on the cranial nerves in the cavernous sinus cause diplopia. Leakage of blood into the subarachnoid space causes unconsiousness and meningeal irritation. PE in pituitary apoplexy shows a hypotensive patient, often with impaired consciousness, who may have signs of nuchal rigidity, photophobia, nausea and vomiting.