A 48-year-old man with a known 2.5 cm pituitary macroadenoma presents with sudden thunderclap headache, bilateral temporal visual field loss, right ptosis, and diplopia. Blood pressure is 86/50 mmHg and sodium 128 mEq/L. The IMMEDIATE next step is:
- A IV hydrocortisone 100 mg ✓
- B Emergency transsphenoidal decompression
- C IV bromocriptine
- D IV levothyroxine loading
Correct answer: A. IV hydrocortisone 100 mg
Explanation
This is pituitary apoplexy with haemorrhagic infarction of the adenoma causing acute cortisol deficiency and shock. High-dose IV hydrocortisone is the immediate life-saving measure and should never be delayed for imaging or surgery. Transsphenoidal decompression follows, ideally within a week, for persistent visual deficits. Bromocriptine has no role in apoplexy. Levothyroxine without cortisol cover can precipitate adrenal crisis, making option D actively harmful.
Reference: Williams Textbook of Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.