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. Diplopia is also usually present with pituitary apoplexy. Laboratory testing Acutely is pretty inconclusive. Electrolytes are usually OK, WBC may be slightly elevated.
Radiology Is diagnostic.
CT scanning usually reveals a lesion in the sellar area with or without subarachnoid blood. MR scanning can delineate this lesion exquisitely. If there is any question, get a stat MR of the sellar area looking for a large macroadenoma. The visual defects, even blindness, can be reversed by rapid decompression of the tumor mass. Delay in surgical decompression may allow permanent blindness to occur.