A patient presenting with pituitary apoplexy may require therapy with corticosteroids if certain indications are identified. The authors are from the Pituitary Apoplexy Guideline Development Group in the UK.


Patient selection: acute pituitary apoplexy


Indications for urgent empirical steroid therapy:

(1) hemodynamic instability

(2) reduced level of consciousness

(3) reduced visual acuity

(4) severe visual field defects


Other indications for steroid therapy:

(1) serum cortisol at 09:00 < 550 nmol/L


Dose for hemodynamic unstable adult:

(1) bolus of intravenous 100-200 mg hydrocortisone

(2) (2-4 mg per hour by continuous intravenous infusion) OR (50-100 mg intramuscular injection every 6 hours)


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