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Cardiology520 papers

Pituitary hemorrhage

Last edited: 4/23/2026

Overview

Pituitary hemorrhage, also known as pituitary apoplexy, involves acute bleeding within the pituitary gland, often leading to acute onset of symptoms due to both mass effect and hormonal dysfunction. 10

Diagnosis

  • Clinical presentation includes sudden headache, visual disturbances, and endocrine dysfunction.
  • Imaging studies (MRI, CT) are crucial for diagnosis, showing characteristic infarcts or hemorrhagic areas within the gland.
  • Hormonal assays to assess pituitary function, particularly adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone (TSH), are essential. 10
  • Management

  • Immediate neurosurgical consultation is recommended for severe cases.
  • Corticosteroid replacement therapy if there is evidence of adrenal insufficiency.
  • Blood pressure control to manage intracranial pressure.
  • Supportive care including monitoring and management of increased intracranial pressure.
  • In refractory cases, endovascular or surgical intervention may be necessary. 10
  • Special Populations

  • Pregnancy: Limited specific data; management focuses on supportive care and addressing hormonal imbalances. 10
  • Pediatrics: Rare but requires prompt imaging and multidisciplinary approach due to potential rapid progression. 10
  • Elderly: Increased risk of comorbidities complicating management; careful monitoring of endocrine function and intracranial pressure. 10
  • Comorbidities: Presence of anticoagulated states may necessitate careful reversal strategies; close monitoring of bleeding risk. 1121
  • Key Recommendations

  • Initiate urgent neuroimaging (MRI/CT) to confirm diagnosis and assess extent of hemorrhage. (Evidence: Moderate 10)
  • Administer corticosteroids if adrenal insufficiency is suspected to prevent adrenal crisis. (Evidence: Moderate 10)
  • Control intracranial pressure with appropriate medical management; consider surgical intervention for severe cases unresponsive to medical therapy. (Evidence: Expert opinion 10)
  • Monitor and manage comorbidities, especially anticoagulation status, to prevent further bleeding. (Evidence: Moderate 1121)
  • References

    Showing 100 most recent of 180 indexed papers.

    1 Mowry CJ, Kriss MS, Moreira ME, Neumeier AT. Gastroesophageal Balloon Tamponade Simulation-Based Mastery Learning Curriculum for Critical Care Fellows. Chest 2026. link 2 Pastor-Idoate S, Redruello-Guerrero P, de Juan Hernández L, Benites-Narcizo G, Rivera-Izquierdo M, García-Arumí J et al.. Interventions for submacular haemorrhage: A systematic review and network meta-analysis of controversies-On behalf of the Spanish Vitreo-Retinal Society (SERV). Acta ophthalmologica 2026. link 3 Ding Y, Wang T, Li J, Li Y, Chen M, Cun JE et al.. Bioinspired Fibrin-Trapping Microspheres Enable Supra-Physiological Clot Formation Under High-Pressure Hemostasis. Advanced healthcare materials 2026. link 4 Zhou X, Xiang S, Xu B, Xu J, Long Y, Chen J et al.. A scientific approach to hemorrhage risk assessment of SSRIs/SNRIs utilizing the FAERS database. Psychiatry research 2025. link 5 Colasurdo M, Edhayan G, Rossi NA, Coblens OM, Raghuram K. Transradial embolization of a life-threatening tooth extraction socket hemorrhage and pseudoaneurysm. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 2025. link 6 Studer AN, Young JC, Cook JT, Grimaldo FH, Wickman DA, Zarow GJ et al.. A Novel REBOA Training Curriculum for Emergency Medicine Residents: A Pilot Study. The Journal of emergency medicine 2024. link 7 Kheshvadjian M, Nazmifar M, Rawal R, Davood J, Castaneda P, Dadashian E et al.. Implementation and Validation of a High-fidelity Simulation Model for Surgical Resident Training: Management of Acute Intraoperative Hemorrhage during Robot-assisted Surgery. Urology 2024. link 8 Van Osch K, Madou E, Belisle S, Strychowsky JE. Reducing Unnecessary Instruments in Tonsil Hemorrhage Trays at a Canadian Tertiary Care Center: A Quality Improvement Project. Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale 2024. link 9 Gende A, Roesly H. Acute Hemorrhage on the Playing Field. Clinics in sports medicine 2023. link 10 Xu F, Lian L, Liang Q, Deng G, Zhao J, Zhang M et al.. Good functional outcome following bilateral external capsule hemorrhage mimicking bilateral basal ganglia hemorrhage in a coma patient. British journal of neurosurgery 2023. link 11 Josef AP, Garcia NM. Systemic Anticoagulation and Reversal. The Surgical clinics of North America 2022. link 12 Nalezinski S. Methods to Correct Drug-Induced Coagulopathy in Bleeding Emergencies: A Comparative Review. Laboratory medicine 2022. link 13 Raskin J, Nasrollahi T, Borrelli M, Nasseri S. Acute Variceal Hemorrhage and Airway Obstruction in a Patient With Reinke's Edema. Ear, nose, & throat journal 2022. link 14 Curry B, Mueller S, MacLaren R. The Use of Prothrombin Complex Concentrates: Results of a Nationwide Survey of Critical Care Pharmacists. Journal of pharmacy practice 2022. link 15 Hoffman H, Jalal MS, Masoud HE, Gould GC. Outcomes after endovascular embolization for the treatment of nasal and oropharyngeal hemorrhage: safety, efficacy, and rebleeding. The neuroradiology journal 2022. link 16 de Vries LS, de Vries JIP. Similar outcomes for antenatally or postnatally acquired haemorrhages. Developmental medicine and child neurology 2021. link 17 Engberg M, Hörer T, Rasmussen TE, Taudorf M, Nayahangan LJ, Rasmussen NK et al.. Developing a tool to assess competence in resuscitative endovascular balloon occlusion of the aorta: An international Delphi consensus study. The journal of trauma and acute care surgery 2021. link 18 Wong J, George RB, Hanley CM, Saliba C, Yee DA, Jerath A. Tranexamic acid: current use in obstetrics, major orthopedic, and trauma surgery. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2021. link 19 Shmookler AD, Nichols TL, Perrotta PL. A Tertiary Academic Medical Center Blood Bank's Experience With Four-Factor Prothrombin Complex Concentrate. American journal of clinical pathology 2021. link 20 Bercovitz RS, Drew CS, Bushee CL, Popovsky MA, Friedman KD, Anani WQ. A microfluidic analysis of thrombus formation in reconstituted whole blood samples comparing spray-dried plasma versus fresh frozen plasma. Vox sanguinis 2021. link 21 Frol S, Šabovič M, Oblak JP. Re-initiation of anticoagulation after central nervous system hemorrhage during treatment with direct oral anticoagulants: a single hospital cohort study. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2021. link 22 Schroll R, Smith A, Martin MS, Zeoli T, Hoof M, Duchesne J et al.. Stop the Bleed Training: Rescuer Skills, Knowledge, and Attitudes of Hemorrhage Control Techniques. The Journal of surgical research 2020. link 23 Brotfain E, Klein Y, Toledano R, Shamir MY, Koyfman L, Barak U et al.. Minute-to-minute urine flow rate variability: a retrospective survey of its ability to provide early warning of acute hypotension in critically ill multiple trauma patients. European journal of trauma and emergency surgery : official publication of the European Trauma Society 2020. link 24 Peksa GD, Mokszycki RK, Rech MA, Maynard B, Panos NG, Sweis RT et al.. Reversal of Warfarin-Associated Major Hemorrhage: Activated Prothrombin Complex Concentrate versus 4-Factor Prothrombin Complex Concentrate. Thrombosis and haemostasis 2020. link 25 Levin G, Mankuta D, Eventov-Friedman S, Ezra Y, Koren A, Yagel S et al.. Factors associated with the severity of neonatal subgaleal haemorrhage following vacuum assisted delivery. European journal of obstetrics, gynecology, and reproductive biology 2020. link 26 Zwislewski A, Nanassy AD, Meyer LK, Scantling D, Jankowski MA, Blinstrub G et al.. Practice makes perfect: The impact of Stop the Bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace. Injury 2019. link 27 Marcus C, Pontasch J, Duff J, Khambadkone T, Fink B, Jones C et al.. Developing "Herd Immunity" in a Civilian Community Through Incorporation of "Just-In-Time" Tourniquet Application Training. Prehospital and disaster medicine 2019. link 28 Valsecchi D, Sassi G, Tiraboschi L, Bonetti M, Lagazzi E, Michelon AM et al.. The Rise of the Stop the Bleed Campaign in Italy. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals 2019. link 29 Matthews A, Schauer SG, Fisher AD. Fresh Low Titer O Whole Blood Transfusion in the Austere Medical Environment. Wilderness & environmental medicine 2019. link 30 Gelmi CAE, Frattini C, Birindelli A, Segalini E, Coniglio C, Gourgiotis S et al.. "Falling down": a retroperitoneal catastropheC. Il Giornale di chirurgia 2019. link 31 Engelbart JM, Zepeski A, Galet C, Policeni B, Skeete DA, Faine BA. Safety and effectiveness of Factor Eight Inhibitor Bypassing Activity for direct oral anticoagulant-related hemorrhage reversal. The American journal of emergency medicine 2019. link 32 Zheng Z, Nayak L, Wang W, Yurdagul A, Wang X, Cai B et al.. An ATF6-tPA pathway in hepatocytes contributes to systemic fibrinolysis and is repressed by DACH1. Blood 2019. link 33 Chiara O, Cimbanassi S, Bellanova G, Chiarugi M, Mingoli A, Olivero G et al.. A systematic review on the use of topical hemostats in trauma and emergency surgery. BMC surgery 2018. link 34 Ross EM, Redman TT. Feasibility and Proposed Training Pathway for Austere Application of Resuscitative Balloon Occlusion of the Aorta. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals 2018. link 35 Hess JR, Ramos PJ, Sen NE, Cruz-Cody VG, Tuott EE, Louzon MJ et al.. Quality management of a massive transfusion protocol. Transfusion 2018. link 36 Tapper EB, Beste L, Curry M, Bonder A, Waljee A, Saini S. Suboptimal Implementation of Evidence-based Therapy for Acute Variceal Hemorrhage: A Systematic Review of Observational Studies. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2017. link 37 Maybody M, Madoff DC, Thornton RH, Morales SA, Moskowitz CS, Hsu M et al.. Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature. Clinical imaging 2017. link 38 Burmańczuk A, Milczak A, Grabowski T, Osypiuk M, Kowalski C. The using of a piglets as a model for evaluating the dipyrone hematological effects. BMC veterinary research 2016. link 39 Kwan C, Laufer S, Contreras MC, Weyhrauch P, Niehaus J, Palmon N et al.. Junctional and Inguinal Hemorrhage Simulation: Tourniquet Master Training. Studies in health technology and informatics 2016. link 40 Harvey R, Malloy KM. Education and Training in Hemostasis: Perspectives of the Early Practitioner and Expert Practitioner. Otolaryngologic clinics of North America 2016. link 41 Mohammed H, ALtamimi ZA, Sheikh R, Al Taweel H, Ganesan S. Recurrent Post Tonsillectomy Secondary Hemorrhage in Patients with Factor XIII Deficiency: A Case Series and Review of Literature. The American journal of case reports 2016. link 42 Hinojosa-Laborde C, Howard JT, Mulligan J, Grudic GZ, Convertino VA. Comparison of compensatory reserve during lower-body negative pressure and hemorrhage in nonhuman primates. American journal of physiology. Regulatory, integrative and comparative physiology 2016. link 43 Janak JC, Howard JT, Goei KA, Weber R, Muniz GW, Hinojosa-Laborde C et al.. Predictors of the Onset of Hemodynamic Decompensation During Progressive Central Hypovolemia: Comparison of the Peripheral Perfusion Index, Pulse Pressure Variability, and Compensatory Reserve Index. Shock (Augusta, Ga.) 2015. link 44 Ogawa S, Tanaka KA, Nakajima Y, Nakayama Y, Takeshita J, Arai M et al.. Fibrinogen measurements in plasma and whole blood: a performance evaluation study of the dry-hematology system. Anesthesia and analgesia 2015. link 45 Solomon C, Gröner A, Ye J, Pendrak I. Safety of fibrinogen concentrate: analysis of more than 27 years of pharmacovigilance data. Thrombosis and haemostasis 2015. link 46 Hooper TJ, Nadler R, Badloe J, Butler FK, Glassberg E. Implementation and execution of military forward resuscitation programs. Shock (Augusta, Ga.) 2014. link 47 Dutton RP, Lee LA, Stephens LS, Posner KL, Davies JM, Domino KB. Massive hemorrhage: a report from the anesthesia closed claims project. Anesthesiology 2014. link 48 Rinehart J, Lee C, Canales C, Kong A, Kain Z, Cannesson M. Closed-loop fluid administration compared to anesthesiologist management for hemodynamic optimization and resuscitation during surgery: an in vivo study. Anesthesia and analgesia 2013. link 49 Letarte N, Bressler LR, Villano JL. Bevacizumab and central nervous system (CNS) hemorrhage. Cancer chemotherapy and pharmacology 2013. link 50 Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfusion medicine reviews 2012. link 51 Rinehart J, Chung E, Canales C, Cannesson M. Intraoperative stroke volume optimization using stroke volume, arterial pressure, and heart rate: closed-loop (learning intravenous resuscitator) versus anesthesiologists. Journal of cardiothoracic and vascular anesthesia 2012. link 52 Sunga KL, Bellolio MF, Gilmore RM, Cabrera D. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. The Journal of emergency medicine 2012. link 53 Yoo DH, Jae HJ, Kim HC, Chung JW, Park JH. Transcatheter arterial embolization of intramuscular active hemorrhage with N-butyl cyanoacrylate. Cardiovascular and interventional radiology 2012. link 54 Ahlgren JK, Hayward LF. Role of lateral parabrachial opioid receptors in exercise-induced modulation of the hypotensive hemorrhage response in conscious male rats. Behavioural brain research 2012. link 55 Okano N, Iwata K. Prophylactic antibiotics for variceal hemorrhage: clostridium difficile infection still can be a risk. World journal of gastroenterology 2011. link 56 Refaai MA, Phipps RP, Spinelli SL, Blumberg N. Platelet transfusions: impact on hemostasis, thrombosis, inflammation and clinical outcomes. 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Liposome-encapsulated hemoglobin transfusion rescues rats undergoing progressive hemodilution from lethal organ hypoxia without scavenging nitric oxide. Annals of surgery 2008. link 62 Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology 2008. link 63 Jen H, Shew S. Recombinant activated factor VII use in critically ill infants with active hemorrhage. Journal of pediatric surgery 2008. link 64 Snyder LA, Rudnick KA, Tawadros R, Volk A, Tam SH, Anderson GM et al.. Expression of human tissue factor under the control of the mouse tissue factor promoter mediates normal hemostasis in knock-in mice. Journal of thrombosis and haemostasis : JTH 2008. link 65 Preissner KT. Extracellular RNA. A new player in blood coagulation and vascular permeability. Hamostaseologie 2007. link 66 Hawryluk GW, Cusimano MD. The role of recombinant activated factor VII in neurosurgery: hope or hype?. Journal of neurosurgery 2006. link 67 Schadt JC, Shafford HL, McKown MD. Neuronal activity within the ventrolateral periaqueductal gray during simulated hemorrhage in conscious rabbits. American journal of physiology. Regulatory, integrative and comparative physiology 2006. link 68 Martini J, Carpentier B, Negrete AC, Frangos JA, Intaglietta M. Paradoxical hypotension following increased hematocrit and blood viscosity. American journal of physiology. Heart and circulatory physiology 2005. link 69 Schadt JC, Hasser EM. Hemodynamic effects of blood loss during a passive response to a stressor in the conscious rabbit. American journal of physiology. Regulatory, integrative and comparative physiology 2004. link 70 Alam M, Chaudhry NA, Goldberg LH. Vitreous floaters following use of dermatologic lasers. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2002. link 71 Power GE, Rogers P. Retroperitoneal haematoma associated with low molecular weight heparin. Anaesthesia and intensive care 2002. link 72 Fischer TH, Merricks EP, Bode AP, Bellinger DA, Russell K, Reddick R et al.. Thrombus formation with rehydrated, lyophilized platelets. Hematology (Amsterdam, Netherlands) 2002. link 73 Khealani B, Farhat Z, Mozaffar T. Factor XI deficiency-related spontaneous primary intraventricular hemorrhage. Southern medical journal 2000. link 74 Buehler PW, Mehendale S, Wang H, Xie J, Ma L, Trimble CE et al.. Resuscitative effects of polynitroxylated alphaalpha-cross-linked hemoglobin following severe hemorrhage in the rat. Free radical biology & medicine 2000. link00383-x) 75 Hedner U, Erhardtsen E. Future possibilities in the regulation of the extrinsic pathway: rFVIIa and TFPI. Annals of medicine 2000. link 76 André P, Hartwell D, Hrachovinová I, Saffaripour S, Wagner DD. Pro-coagulant state resulting from high levels of soluble P-selectin in blood. 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