Best of five
- A. Emergency endocrine, neurosurgical and ophthalmic assessment for pituitary apoplexy
- B. Treat as uncomplicated sinusitis
- C. Arrange routine allergy testing
- D. Perform septoplasty
- E. Delay imaging until visual fields recover
FRCS (ORL-HNS) · SECTION 1 SBA
Pituitary apoplexy after sinonasal presentation
A patient presents with sudden severe retro-orbital headache, ophthalmoplegia and rapidly deteriorating vision. CT sinuses is unremarkable. What is the most important next action?
A. Emergency endocrine, neurosurgical and ophthalmic assessment for pituitary apoplexy
The acute headache, ocular motor palsy and visual loss suggest sellar haemorrhage. Urgent steroids may be lifesaving when adrenal insufficiency is suspected, followed by MRI and decompression decisions.
Why every option is right or wrong
A. Emergency endocrine, neurosurgical and ophthalmic assessment for pituitary apoplexy: The acute headache, ocular motor palsy and visual loss suggest sellar haemorrhage. Urgent steroids may be lifesaving when adrenal insufficiency is suspected, followed by MRI and decompression decisions.
B. Treat as uncomplicated sinusitis: The neurological and visual features are incompatible.
C. Arrange routine allergy testing: This is a neuroendocrine emergency.
D. Perform septoplasty: Septal anatomy does not explain ophthalmoplegia.
E. Delay imaging until visual fields recover: Delay risks permanent blindness and haemodynamic collapse.
What if the scenario changed?
If fever, nasal necrosis and immunosuppression were present, invasive fungal sinusitis would become the leading emergency differential.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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