Pituitary Disorders USMLE Step 1 Practice Question
A 48-year-old woman with a history of prolactinoma managed with cabergoline presents with acute severe headache, bitemporal hemianopsia, and confusion. Vital signs show BP 148/92, HR 92, RR 18, temp 37.2°C, SpO2 98% on room air. MRI demonstrates rapid sellar mass enlargement with intrasellar hemorrhage and suprasellar extension compressing the optic chiasm. Serum sodium is 128 mEq/L. No focal neurologic deficits are noted. Which of the following is the most appropriate immediate management?
Answer choices
- AHormone replacement therapy only
- BHigh-dose dopamine agonist therapy
- CObservation with serial imaging
- DDexamethasone and supportive care
- EEmergent transsphenoidal decompressionCorrect answer
- FImmediate administration of bromocriptine with close clinical monitoring
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