Pituitary Apoplexy and Sheehan’s Syndrome

00:02 Differences between apoplexy and Sheehan.

00:04 What’s apoplexy? I told you that the-the pathogenesis that it shares with would be more or less with massive haemorrhage into the adrenals.

00:13 That’s Waterhouse–Friderichsen, completely different.

00:16 But, this is acute haemorrhage into the pituitary tumour resulting in what? Good.

00:21 Pituitary insufficiency.

00:22 There will be sudden headache because now, literally, sella’s filling up with blood so very quickly.

00:27 It’s going to be a sudden headache and the fact that the optic chiasm is been affected or compromised resulting in bitemporal hemianopsia.

00:36 It might also have issues with cranial nerves III oculomotor, trochlear 4 and then maybe something like your 6 abducens, meaning to say you’re going to have visual issues.

00:48 With this sudden rush of blood into your sella, this is not about you going in there and removing a tumour.

00:57 This is about you relieving that pressure ASAP.

01:01 Once again, when this is taking place, what’s the most important hormone that you’re always paying attention to? It’s the cortisol, cortisol, cortisol.

01:08 In addition, understand that the pituitary… Do not, I mean, when there’s talk about insufficiency, do not just restrict yourself to the anterior pituitary.

01:17 Your patient might not have ADH, may result in symptoms of what? Central diabetes insipidus.

01:22 Are we clear? Are we clear? Most dangerous of them all would be your secondary adrenal insufficiency due to lack of ACTH.

01:30 So, what’s your treatment? Please make sure that you treat your patient, manage, manage, manage.

01:36 Glucocorticoid, glucocorticoid, glucocorticoid.

01:38 I cannot stress that enough.

01:40 There will be certain interesting topics that we’ll walk through there.

01:45 When we start talking about the most common cause of Cushing in the United States is iatrogenic, isn’t it? Exogenous, factitious, all the same thing.

01:59 And we’ll talk about a very important scenario in which you really want to make sure that you’re very clear about how the adrenals would die and how a patient with Cushing is going to present.

02:17 And I would try to reinforce that over and over again and I will make sure that I do that for you.

02:24 Listen.

02:25 If you take prednisone, cortisol, you can call it cortisol, then you’re going to look like Cushing.

02:33 When you take cortisol, who’s being supressed? The body is fooled.

02:42 The ACTH will be supressed and the adrenals undergo atrophy.

02:47 Isn’t that interesting? So, the patient looks like Cushing in the US, right? Exogenous.

02:57 Internally, what’s going on with your patient? Secondary hypocortisolism.

03:03 Isn’t that fascinating? Make sure that you’re clear with that.

03:07 If you’re not, that’s okay, I’ll keep repeating, like I have been doing it with everything else.

03:11 By the time it becomes… by the time we’re done, it will be part of your subconscious reflex.

03:16 You want to make sure with this apoplexy that you immediately relieve the pressure.

03:22 Decompression surgically.

03:24 It’s an urgency.

03:27 Versus Sheehan.

03:28 In Sheehan, we talked about the pregnant woman who is-who is having massive haemorrhage and during that haemorrhage, there’s going to be pretty massive pituitary infarction.

03:39 This is called Sheehan.

03:40 She’s going to then present with lack of the ability to lactate and breastfeed her child.

03:47 And as far as management is concerned, you want to make sure that she’s able to properly survive with her stress hormone called? Cortisol, good.

03:58 Pituitary insufficiency.

04:01 Apoplexy versus Sheehan.

04:03 This is Sheehan.