Pituitary apoplexy is an acute clinical condition caused by either hemorrhagic or non-hemorrhagic necrosis of the pituitary gland, most common in people between the ages of 37 and 58.

RISK FACTORS

• Medical treatment of a prolactinoma (especially with bromocriptine)
• prior irradiation of the mass
• pregnancy (Sheehan syndrome)
• cerebral angiography
• trauma and surgery
• anticoagulation therapy
• changes in intracranial pressure

CLINICAL FEATURE

• Sudden headache, including of 'thunderclap' nature, often retro-orbital or between eyes
• loss of visual acuity with a chiasmal field defect
• oculomotor palsies
• Double vision.
• Drooping eyelid.
• Partial or full vision loss in one or both eyes
• Confusion.
• Fatigue.
• Fever.
• Nausea and vomiting.
• Sensitivity to light (photophobia).

DIAGNOSIS:

• CT scan
• MRI

DIFFERENTIAL DIAGNOSIS:

• necrotic/hemorrhagic pituitary macroadenoma
• adamantinomatous craniopharyngioma
• Rathke cleft cyst

HOMOEOPATHIC MANAGEMENT:

Aconitum : Heat of the head; pulsation of the carotids; skin more warm than cold; pulse full, hard, strong, even suppressed, but not intermittent; especially when fright or vexation was the cause of it, in plethoric apoplectic subjects.

Arnica : Head hot and rest of body cool; full and strong pulse, with paralysis of limbs, especially left side; loss of consciousness and stupefaction, with stertorous breathing; sighing, muttering; involuntary discharge of urine and faces. Suits middle-aged, plethoric and stout constitutions; ecchymoses here and there all over the body.

Asterias-rubens : Sudden attack of vertigo like shocks in the head; heat of head, as if surrounded by hot air; cerebral congestion with obstinate constipation; face red; pulse hard, compressed, frequent; pupils closed; gradual loss of sight; great agitation and little sleep night before attack.

Baryta-carb: Apoplexy of old people, especially those addicted to the excessive use of stimulating drinks; the patient cannot speak; acts childish, at times anxious and full of fear; general PARALYSIS OF OLD AGE; paralysis of the tongue, with loss of memory; anxiety and fear and great trembling of the limbs; inability to keep the body erect.

Belladonna : The first stage of the disease, with grinding and gnashing of teeth before attack, where severe congestive symptoms are still present, or at a later period, when the extravasation causes severe inflammatory reaction; stupefaction; loss of consciousness and speech, or convulsive movements of the limbs and muscles of the face; paralysis of the extremities, especially on the right side.

Cactus-grand : Vertigo from sanguineous congestions to the head; face bloated and red, with pulsating pain in the head; heat in the head and face, causing madness and horrible anxiety; pulsating pain with sensation of weight on the right side of the head; pressing pain in the forehead, increased by bright light and loud noises. All these symptoms caused by profound cardiac disturbance.

Calcarea-carb : With fat persons, suffering also from fatty degeneration of the heart, and atheromatous state of the blood-vessels.

Causticum : Paralytic states remaining after the apoplexy is removed. Paralysis and contraction of the lower extremities; impossibility to find the right word.

Cocculus : Face red and hot; eyes closed with the balls constantly rolling about; pupils dilated; breathing without noise; stupor; paralysis of right or left extremity; after night-watching and exhaustion.

Coffea  : Threatening of apoplexy; overexcited, talkative, full of fear, pangs of conscience; aversion to open air; sleeplessness; convulsive grinding of teeth.

Conium : The senile women’s remedy; numbness, with sensation of coldness on one side of head; headache, as if head were to full and would burst, morning when awaking; hemiplegia, sweat as soon as he falls asleep and even with the closing of the eyes.

Crot.-hor : Apoplexy in drunkards, broken-down constitutions, following toxaemic states; dull, heavy, throbbing headache, with oppression in chest, burning fever and accelerated pulse; loss of speech; sopor from which he cannot be aroused; muttering and lockjaw; paralysis, following apoplexy, especially right side.

Cuprum : Nervous apoplexy, with convulsions, distortions of face and palsy of speech. Atrophy of paralyzed parts with paralysis of motor nerves, whereas sensation is normal; paralysis of tongue; choreic movements.

Gelsemium  : Threatened or actual apoplexy, with stupor, coma and nearly general paralysis (rarely useful in hemiplegia or paraplegia); headache, nausea, tightness of brain; giddiness, tendency to stagger, with imperfection of vision; vertigo unto falling, slightly relieved by spirits; intense passive congestion to the head with nervous exhaustion; wine aggravates the headache and eye symptoms.

Glonoinum : Threatening apoplexy in subjects having a hypertrophied heart or insufficiency of aortic valves; during prodromal stage severe headache, hot flashes in head and face, mental exaltation or depression, ill humor, anguish, pulsation of the arteries of the head and neck; stiff neck and painful sensation at the back of neck, as if clothing were too tight.