syndrome caused by haemorrhage or infarction of the pituitary gland, usually affecting a pituitary adenoma.

Precipitating factors include high blood pressure, major surgery, pregnancy and head injury. \

Associated with rapid onset of:

• severe headache (the presentation may be confused with a subarachnoid haemorrhage)
• neck stiffness
• visual field defect
• diplopia from cranial nerve palsies
• hypopituitarism (adrenocorticotrophic hormone [ACTH] deficiency is the most common deficiency).

Management

• immediate referral to MDT including an endocrinologist and a neurosurgeon.
• If visual loss → surgical decompression within 8 days to avoid irreversible visual loss.
• if visual defects from prolactinoma, can try acute dopamine agonists first and then do surg if no resolution
• IVHydrocortisone for glucocorticoid replacement
• IV Dexamethasone for reducing oedema