Treatment of Central Adrenal Insufficiency in Pituitary Apoplexy with Acute Adrenal Insufficiency

Pituitary apoplexy can precipitate acute adrenal insufficiency — a life-threatening emergency in which rapid cortisol deficiency demands immediate recognition and treatment. Because acute adrenal insufficiency is a major cause of mortality in this setting, treatment must begin promptly and cannot await laboratory confirmation.

Clinical Scenario

This protocol addresses patients presenting with pituitary apoplexy who develop acute adrenal insufficiency. Recognising secondary adrenal insufficiency in the context of pituitary apoplexy is critical; delayed treatment risks adrenal crisis. Glucocorticoid therapy should be initiated promptly to prevent crisis, and maintained until normal pituitary function is confirmed.

Treatment Approach

The cornerstone of management is prompt glucocorticoid therapy. The route and form of administration depend on the patient's clinical status and ability to tolerate oral medications.

Full dosing schedule, route selection, and clinical algorithm available in the complete protocol →

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References

DOI: 10.1210/jc.2016-2118

Because acute AI is a major cause of mortality, we recommend GC therapy until a laboratory diagnosis is established and the patient maintains normal pituitary function.

Recognizing acute secondary AI is critical, and patients should begin GC therapy promptly to prevent AC.

When patients cannot tolerate oral medications, they should begin with a 100–200 mg iv HC bolus followed by 2–4 mg/h by continuous infusion or 50–100 mg injections every 6 hours.

Clinicians have also used high doses of dexamethasone to treat pituitary apoplexy.

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