A 44-year-old man with a known pituitary macroadenoma presents with sudden severe headache, visual deterioration, ophthalmoplegia, and altered sensorium. MRI shows a hemorrhagic enlarged sellar mass. Emergency management before definitive surgery includes:

• A Immediate glucocorticoid replacement and fluid resuscitation ✓
• B High-dose dopamine agonist therapy alone
• C Octreotide infusion and beta blockade
• D Transsphenoidal decompression within one week as elective surgery

Explanation

Pituitary apoplexy is hemorrhagic infarction of an adenoma causing acute adrenal insufficiency, which can be fatal. Immediate parenteral hydrocortisone and hemodynamic support precede any intervention. Dopamine agonists are slow acting and inappropriate in an emergency, octreotide treats acromegaly pharmacologically rather than apoplexy, and delayed elective decompression risks death from cortisol deficiency and worsening visual compromise. Urgent transsphenoidal surgery follows once steroids are given.

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

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Written and medically reviewed by the StethoPrep medical team.