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Non-functioning pituitary macroadenoma — SCE Endocrinology MCQ

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ModeratePituitaryNon-functioning pituitary macroadenomaSCE Endocrinology

A 61-year-old man has a non-functioning pituitary macroadenoma compressing the optic chiasm. Visual fields show bitemporal hemianopia and morning cortisol is 145 nmol/L. Free T4 is low with inappropriately normal TSH. What is the most appropriate management sequence?

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Reveal the answer and explanation

Correct answer: B — Replace glucocorticoid deficiency before starting levothyroxine and refer for surgery

Replace glucocorticoid deficiency before starting levothyroxine and refer for surgery is best because central hypothyroidism should not be treated before steroid cover because thyroxine can precipitate adrenal crisis. The alternatives are less appropriate because levothyroxine first is risky; cabergoline is not definitive for most non-functioning tumours; radioiodine is irrelevant; observation is unsafe with chiasmal compression. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Society for Endocrinology hypopituitarism guidance