A previously healthy gentleman presents with sudden onset excruciating headache and diplopia. In the emergency department, he has persistent hypotension refractory to aggressive fluid resuscitation. A T1-weighted MRI is shown above.Challenge: What's your diagnosis?
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Struck Dumb
This is pituitary apoplexy, which historically meant being “struck dumb.” The image shows a large suprasellar mass with hetergenous gadolinium enhancement representing sudden hemorrhage. The preexisting lesion is usually an adenoma. The hypotension is due to cortisol deficiency.
Sources: UpToDate; bestpractice.bmj.com.
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