A 50-year-old man with a known 2.5 cm pituitary macroadenoma develops sudden severe headache, bilateral temporal visual loss, and ptosis with ophthalmoplegia over 6 hours. He is drowsy and BP is 88/50 mmHg. What is the immediate priority?
- A Urgent transsphenoidal decompression within the hour
- B High-dose oral prednisolone and observation
- C IV hydrocortisone 100 mg followed by urgent imaging and surgical decompression ✓
- D IV mannitol and neurosurgical consultation for craniotomy
Correct answer: C. IV hydrocortisone 100 mg followed by urgent imaging and surgical decompression
Explanation
This is pituitary apoplexy with haemorrhagic infarction of the adenoma causing acute hypoadrenalism and cavernous sinus compression. Corticosteroid replacement comes first because untreated ACTH deficiency is life-threatening; surgery follows once stabilised, ideally within 7 days for visual deficits. Operating before correcting cortisol risk cardiovascular collapse. Oral prednisolone is inadequate in shock, and mannitol does not address the hormonal emergency. Visual recovery correlates with early decompression after stabilisation.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.