症例 challenge · Endocrinology / Neurosurgery / Ophthalmology · teaching

Pituitary Apoplexy Pathway · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

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Case #1Endocrinology / Neurosurgery / Ophthalmology

📋 Case data

Is pituitary apoplexy suspectedPituitary apoplexy suspected

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Is pituitary apoplexy suspected

Sudden severe headache + visual/ocular motor signs — pituitary apoplexy suspected?

💡 Sudden hemorrhage/infarction of the pituitary (usually a pre-existing adenoma) → rapid sellar expansion compressing the pituitary/optic chiasm/cavernous sinus. Presentation: sudden severe headache + nausea/vomiting + visual field defect (bitemporal hemianopia)/visual loss + ophthalmoplegia (CN III/IV/VI) + altered consciousness (apoplexy triad: headache + vomiting + visual disturbance), mimicking SAH/meningitis. Most urgent: acute adrenal insufficiency (ACTH deficiency) → hypotension/circulatory collapse/hyponatremia/hypoglycemia. Diagnosis: urgent MRI; check cortisol/ACTH/electrolytes/glucose.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.