A 36-year-old woman with a known 2 cm pituitary macroadenoma presents with sudden thunderclap headache, right ptosis, diplopia, and drowsiness. CT shows haemorrhage into the sellar mass. Along with fluid resuscitation, what is the most appropriate IMMEDIATE drug therapy?

• A High-dose dexamethasone given solely to reduce peritumoural oedema
• B Oral cabergoline to shrink the haemorrhagic adenoma
• C Intravenous desmopressin to prevent subsequent diabetes insipidus
• D Intravenous hydrocortisone 100 mg, started before any surgical intervention ✓

Explanation

Pituitary apoplexy frequently destroys corticotrophs, producing life-threatening secondary adrenal insufficiency, so high-dose parenteral hydrocortisone is given immediately, both as replacement and to reduce pressure effects. Dopamine agonists have no role in apoplexy, and desmopressin is used only if diabetes insipidus actually develops. Definitive transsphenoidal decompression follows stabilisation, particularly with visual loss, but glucocorticoid cover comes first.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.