Pituitary apoplexy is hemorrhage or infarction within the pituitary, often within an unrecognized adenoma. It can deteriorate rapidly because swelling damages pituitary tissue and compresses visual or cranial nerve structures. Suspect apoplexy when a patient develops sudden severe headache with nausea, vomiting, visual field loss, diplopia, ptosis, ophthalmoplegia, altered consciousness, or hemodynamic instability. The presentation can resemble subarachnoid hemorrhage, meningitis, migraine, or stroke. The combination of thunderclap headache and ocular findings should prompt urgent evaluation for a pituitary emergency. Acute ACTH deficiency is a major cause of death in pituitary apoplexy. For hemodynamic instability, reduced consciousness, or significant visual compromise, hydrocortisone is given immediately: 100 to 200 mg IV as a bolus followed by infusion, or 50 to 100 mg IM every 6 hours. Urgent endocrine, neurosurgical, and ophthalmologic evaluation is required. Magnetic resonance imaging is preferred when the patient is stable enough, but treatment for suspected adrenal insufficiency must not wait for imaging. For NCLEX-RN (United States), items rarely announce the topic in the first sentence. Anchor to objective data, trajectory, and the safest next step for the role...