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Pituitary apoplexy with adrenal insufficiency — SCE Acute Medicine MCQ

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HardAcute Neurological PresentationsPituitary apoplexy with adrenal insufficiencySCE Acute Medicine

A 58-year-old woman presents with sudden severe headache, vomiting and diplopia. She has known pituitary macroadenoma awaiting surgery. Examination shows right third nerve palsy, visual field loss and BP 86/48 mmHg. Sodium is 126 mmol/L and random cortisol is very low. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous hydrocortisone with endocrine and neurosurgical assessment

Headache, visual loss, ocular palsy, shock, hyponatraemia and low cortisol in a patient with a macroadenoma indicate pituitary apoplexy with acute ACTH deficiency. Give intravenous hydrocortisone immediately and arrange urgent endocrine, neurosurgical and ophthalmological review. Imaging and formal fields must not delay steroid treatment.

Reference: https://doi.org/10.1530/EC-16-0057