A 34-year-old woman with a known pituitary macroadenoma presents with sudden severe headache, visual field loss, ophthalmoplegia, and altered sensorium. MRI shows hemorrhage into the sellar mass. Immediate management before definitive therapy includes:

• A Cabergoline therapy with outpatient MRI follow-up
• B Octreotide infusion followed by elective transsphenoidal surgery after six weeks
• C High-dose oral hydrocortisone replacement and urgent neurosurgical decompression ✓
• D Radiotherapy to the sella within 24 hours

Explanation

Pituitary apoplexy is acute hemorrhagic infarction of a pituitary adenoma causing mass effect on the optic chiasm and cavernous sinuses plus acute hypopituitarism. Because cortisol deficiency can be immediately life threatening, parenteral then high-dose glucocorticoid replacement is given alongside urgent surgical decompression when vision or consciousness is threatened. Cabergoline and octreotide treat functioning adenomas electively and have no role in the acute apoplectic event.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.