This handout is for pituitary apoplexy. Your care team identified this based on: sudden severe (thunderclap) headache + visual disturbance (rajasekaran clin endocrinol 2011).
Other reasons your team may use this plan: hypotension / shock with sudden headache — secondary adrenal insufficiency (rajasekaran clin endocrinol 2011; briet endocr rev 2015); acute ophthalmoplegia / diplopia (cavernous sinus cn iii/iv/vi) (rajasekaran clin endocrinol 2011); sellar/suprasellar mass with hemorrhage on mri/ct (rajasekaran clin endocrinol 2011).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| hydrocortisone | 100 mg IV/IM bolus STAT, then 50 mg IV q6h OR 200 mg/24h continuous infusion (≥2 mg/h) | IV | q6h or continuous infusion | UK 2011 — secondary (ACTH-deficient) adrenal insufficiency is the life-threatening facet; empiric hydrocortisone is the single most urgent step and is mortality-reducing; give before imaging confirmation |
| dexamethasone | 4 mg IV (only if hydrocortisone unavailable, or high-dose anti-edema effect desired with significant chiasmal mass effect) | IV | q6h | UK 2011 — alternative glucocorticoid; preserves cortisol-assay window; some use higher-dose dexamethasone for perichiasmal edema, but hydrocortisone is the default replacement steroid |
Plan: Pituitary apoplexy acute — empiric steroid FIRST → resuscitate/Na → image + surgical decision → staged hormone replacement (Rajasekaran Clin Endocrinol 2011)
Call 911 or go to the nearest emergency room right away if you have:
Endocrinology re-evaluation of all anterior axes at 4–8 weeks (most need long-term replacement; ~80% deficient ≥1 axis), interval pituitary MRI, ophthalmology field re-assessment, steroid sick-day rules + emergency hydrocortisone kit + MedicAlert, neurosurgical follow-up of residual adenoma (Rajasekaran Clin Endocrinol 2011; Briet Endocr Rev 2015)
Guideline: 2011 UK Pituitary Apoplexy Guideline (Rajasekaran, Clin Endocrinol) + 2016 Endocrine Society Hypopituitarism Guideline (Fleseriu JCEM) + Briet Endocr Rev 2015 review + 2021–2025 updates