Pituitary Disorders — Clinical

A 52-year-old man presents with a 3-month history of severe headaches, diplopia, and acute-onset left eye ptosis. On examination, he is alert but confused, with a left third cranial nerve palsy and neck stiffness. Temperature is 38.2°C. MRI pituitary shows a 3.5 cm sellar mass with hemorrhage and surrounding edema. CSF analysis reveals: protein 180 mg/dL, glucose 35 mg/dL (serum glucose 110 mg/dL), WBC 250/μL (80% lymphocytes). What is the most likely diagnosis?

A 38-year-old woman presents to the endocrinology clinic with a 6-month history of amenorrhea, galactorrhea, and progressive visual field defects (bitemporal hemianopsia). On examination, she has mild hirsutism and acne. Serum prolactin is 2800 mIU/L (normal <25), and MRI pituitary shows a 2.5 cm mass with suprasellar extension compressing the optic chiasm. Which of the following is the most appropriate initial management?

A 52-year-old man is referred to the endocrinology clinic for evaluation of hyponatremia (Na⁺ 118 mEq/L) and lethargy. He reports a 3-week history of severe headache, diplopia, and sudden-onset confusion. On examination, he is drowsy, has a stiff neck, and shows signs of meningeal irritation. Fundoscopy reveals no papilledema. CT head shows a sellar mass with blood within it. Serum osmolality is 245 mOsm/kg, urine osmolality is 680 mOsm/kg, and urine sodium is 95 mEq/L. Which of the following is the most appropriate immediate management?

A 38-year-old woman from Delhi presents with progressive headaches and amenorrhea for 8 months. On examination, she has bitemporal hemianopia and galactorrhea. Serum prolactin is 280 ng/mL (normal <25 ng/mL). MRI pituitary shows a 2.2 cm sellar mass with suprasellar extension compressing the optic chiasm. What is the most appropriate initial management?

A 52-year-old man from Mumbai presents with sudden-onset severe frontal headache, neck stiffness, and diplopia. He has a known history of a pituitary adenoma diagnosed 2 years ago for which he declined surgery. On examination, he is febrile (38.5°C), has bilateral ptosis, and impaired upward gaze. Blood glucose is 420 mg/dL. Non-contrast CT head shows hyperdensity in the sella turcica with blood in the subarachnoid space. What is the most likely diagnosis?