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Non-functioning pituitary macroadenoma — SCE Endocrinology MCQ

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ModeratePituitaryNon-functioning pituitary macroadenomaSCE Endocrinology

A 63-year-old man has a 2.8 cm non-functioning pituitary macroadenoma compressing the optic chiasm. He has bitemporal hemianopia and low morning cortisol. What is the most appropriate management sequence?

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Correct answer: E — Replace glucocorticoids urgently and refer for trans-sphenoidal decompression

Visual field compromise from a non-functioning macroadenoma usually requires surgical decompression, but cortisol deficiency must be treated first. Starting levothyroxine before glucocorticoid replacement can precipitate adrenal crisis. Cabergoline is not primary therapy for a non-functioning compressive adenoma.

Reference: Society for Endocrinology Pituitary Guidance