Endocrinology: pituitary apoplexy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: pituitary apoplexy

Sample item

A 45-year-old with a known pituitary macroadenoma develops a sudden severe headache, visual loss, ophthalmoplegia and hypotension. What is the immediate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous hydrocortisone with urgent imaging and neurosurgical review

Pituitary apoplexy is haemorrhage or infarction of an adenoma, and acute ACTH deficiency can cause fatal adrenal crisis. High-dose hydrocortisone is given immediately, followed by MRI and decompressive surgery if there is visual or neurological deterioration. Thyroid replacement before steroid can worsen adrenal crisis.

Option by option

  • A. Intravenous hydrocortisone with urgent imaging and neurosurgical review (correct)

    Correct. Steroid replacement is urgent and life-saving.

  • B. Levothyroxine first

    Giving thyroxine before glucocorticoid can precipitate adrenal crisis.

  • C. Cabergoline alone

    Cabergoline does not treat the acute emergency.

  • D. Observation for a week

    Delay risks permanent visual loss and death.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Intravenous hydrocortisone with urgent imaging and neurosurgical review. Pituitary apoplexy is haemorrhage or infarction of an adenoma, and acute ACTH deficiency can cause fatal adrenal crisis.

Why is "Levothyroxine first" not the answer?

Giving thyroxine before glucocorticoid can precipitate adrenal crisis.

Why is "Cabergoline alone" not the answer?

Cabergoline does not treat the acute emergency.

Why is "Observation for a week" not the answer?

Delay risks permanent visual loss and death.

What concept does this question test?

It tests Endocrinology: pituitary apoplexy in General Medicine. High-dose hydrocortisone is given immediately, followed by MRI and decompressive surgery if there is visual or neurological deterioration. Thyroid replacement before steroid can worsen adrenal crisis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: pituitary apoplexy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.