A 63-year-old woman comes to the emergency department reporting severe headache with signs of meningeal irritation, bilateral visual disturbances and ophthalmoplegia. A CT scan showed a 2 cm space-occupying lesion in the sella turcica compatible with pituitary adenoma with signs of intratumoral hemorrhage, with deviation of the pituitary stalk and compression of the glandular tissue. Mark which of the following answers is WRONG:
Very difficult question of pituitary apoplexy. It is a marginal topic in the MIR and also the answer is complex. Eliminating answers we are left with intervene (answer 4) or not to intervene (answer 2). In patients with hemodynamic instability, decreased level of consciousness, decreased visual acuity and extensive visual field defects, surgical decompression is recommended in the first week after symptom onset. I think the answer is 4, although it is oddly worded. I don't know if the neurosurgeon will support my answer.
Diagnostic suspicion is pituitary apoplexy.
Treatment with high-dose corticosteroids should be initiated and the evolution observed, since this treatment could reduce the volume of the lesion and avoid intervention.
Treatment with glucocorticoids should be considered to avoid secondary adrenal insufficiency that would compromise the patient's vital prognosis.
The presence of ophthalmoplegia and visual defects are indications for prompt intervention by urgent surgical decompression.
After resolution of the acute picture, the development of panhypopituitarism is frequent.
In patients with hemodynamic instability, decreased level of consciousness, decreased visual acuity and extensive visual field defects, surgical decompression is recommended in the first week after symptom onset.