Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Image urgently when anatomy is the emergency
Sudden severe headache with visual loss, ophthalmoplegia or reduced consciousness suggests pituitary apoplexy; airway compromise from a neck mass, spinal cord compression, or an unstable catecholamine syndrome also requires emergency assessment. In these situations imaging accompanies resuscitation and specialist contact rather than waiting for leisurely biochemical confirmation.
Action: Use ABCDE, check glucose and electrolytes, protect steroid-dependent physiology when adrenal compromise is suspected, and contact the appropriate acute endocrine, neurosurgical, ophthalmic or airway team. Select the emergency modality with radiology and local protocols; do not delay time-critical glucocorticoids for pituitary imaging.
Synopsis
Select endocrine imaging only when it answers a defined anatomical question, and refer urgently when structure or hormone activity threatens vision, neurology or physiology.
For stable endocrine disease, establish a credible biochemical syndrome before looking for its anatomical source; common incidental lesions otherwise create misleading causality.
Imaging defines location, extent and complications but rarely proves whether a lesion secretes hormone, so anatomical and functional questions must remain separate.
A thyroid ultrasound is driven by a palpable nodule, cervical lymphadenopathy, compressive concern or surveillance indication, not by an abnormal TSH alone.
Investigation priorities
01
Dedicated pituitary MRIFirst step
Define sellar anatomy, optic-chiasm relationship, invasion and a potential source after biochemical or neurological indication.
Management branches
SequenceConfirm function before stable localisation
A stable patient has a possible hormone-excess or deficiency syndrome without acute compression.
Define and confirm the biochemical phenotype using appropriately timed basal or dynamic tests, reviewing medicines and assay limitations.
Select the gland-specific modality only after the result establishes a localisation question, and include the hormone data in the imaging request.
Key medicines
Hydrocortisone for suspected pituitary apoplexy with adrenal compromiseGive emergency parenteral hydrocortisone promptly according to the Society for Endocrinology and local emergency regimen when haemodynamic instability, altered consciousness or other evidence of acute ACTH deficiency is present.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.