Chronic tension-type headache — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardAmbulatory Medicine / Primary CareChronic tension-type headacheUSMLE Step 3

A patient with a known pituitary macroadenoma develops sudden severe headache, ophthalmoplegia, bitemporal visual loss, hypotension and sodium 126 mEq/L. What should be given immediately while urgent imaging and neurosurgical evaluation are arranged?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Give parenteral hydrocortisone

The best answer is “Give parenteral hydrocortisone”. Pituitary apoplexy can abruptly cause ACTH deficiency and shock. Stress-dose parenteral hydrocortisone is given immediately, before thyroid hormone or definitive neurosurgical decisions, while urgent MRI and specialty evaluation proceed. Suspected acute secondary adrenal insufficiency in pituitary disease requires immediate parenteral glucocorticoid treatment; pituitary apoplexy with visual or neurologic deficits also requires urgent imaging and neurosurgical evaluation.

Reference: Endocrine Society Guideline: Hormonal Replacement in Hypopituitarism in Adults: https://www.endocrine.org/clinical-practice-guidelines/hormone-replacement-in-hypopituitarism