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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