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Pituitary apoplexy — RCPSC IM MCQ

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HardEndocrinologyPituitary apoplexyRCPSC IM

A 56-year-old man develops sudden severe headache, vomiting and diplopia. Examination shows left third nerve palsy and bitemporal field loss. Sodium is 128 mmol/L, morning cortisol is low, and CT head shows a sellar mass with hemorrhage. What is the most appropriate next step?

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Correct answer: D — Give stress-dose hydrocortisone and arrange urgent pituitary MRI and neurosurgical assessment

Pituitary apoplexy with neuro-ophthalmic deficits and adrenal insufficiency requires immediate stress-dose glucocorticoids, urgent MRI and neurosurgical/endocrine involvement. Full endocrine testing must not delay steroid therapy.

Reference: Endocrine Society pituitary incidentaloma/apoplexy practice; Canadian endocrine practice