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Pituitary apoplexy — RACP Adult Medicine MCQ

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HardEndocrinology and diabetesPituitary apoplexyRACP Adult Medicine

A 56-year-old man develops sudden severe headache, vomiting and diplopia. Examination shows bitemporal field loss and right third nerve palsy. Sodium is 128 mmol/L and morning cortisol is low. CT shows haemorrhage in an enlarged pituitary fossa. What is the most likely diagnosis?

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Correct answer: E — Pituitary apoplexy

Sudden headache with ophthalmoplegia, visual field loss, pituitary haemorrhage and adrenal insufficiency indicates pituitary apoplexy. Subarachnoid haemorrhage does not explain sellar haemorrhage with hypopituitarism. Cavernous sinus thrombosis, migraine and idiopathic intracranial hypertension do not fit the imaging and endocrine pattern.

Reference: Therapeutic Guidelines (eTG) Endocrinology; AMH