A 45-year-old woman on the third day post-transsphenoidal pituitary surgery develops sudden severe headache, bilateral visual loss, and ophthalmoplegia involving the third, fourth, and sixth cranial nerves. What is the most appropriate immediate management?

• A Urgent MRI brain with contrast
• B Intravenous hydrocortisone and urgent surgical re-exploration ✓
• C High-dose dexamethasone and observation
• D CT angiography to rule out carotid artery injury

Explanation

Pituitary apoplexy presents with sudden headache, visual loss, and ophthalmoplegia due to hemorrhage or infarction of a pituitary adenoma. It is a neurosurgical emergency requiring immediate intravenous glucocorticoids (hydrocortisone) to address adrenal insufficiency and urgent surgical decompression to preserve vision. Observation or delaying surgery for imaging risks permanent visual loss.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.