How should I initiate emergency management for a patient suspected of having pituitary apoplexy in a primary care setting?

Initiate emergency management for suspected pituitary apoplexy in primary care by:

• Recognising the emergency: Pituitary apoplexy often presents with sudden headache, visual disturbance, altered consciousness, and signs of acute adrenal insufficiency.
• Administer immediate parenteral hydrocortisone: Give intravenous or intramuscular hydrocortisone promptly to treat potential acute adrenal crisis, as there is no risk of overdose in emergency situations.
• Arrange urgent transfer to hospital: Call for an ambulance to transfer the patient immediately to an emergency department for specialist assessment and management.
• Supportive care: While awaiting transfer, monitor vital signs including blood pressure, heart rate, and consciousness level, and provide supportive care as needed.

This approach aligns with emergency management principles for adrenal crisis, which is a common and life-threatening complication of pituitary apoplexy, and the need for urgent specialist care in suspected acute intracranial events.

References: Immediate hydrocortisone administration and urgent hospital transfer are recommended for adrenal crisis management NICE NG243. Pituitary apoplexy is a neurosurgical emergency requiring rapid recognition and referral NICE NG232,NICE NG243.