The patient has acute apoplexy caused by pituitary hemorrhage and requires urgent transsphenoidal decompression of the hemorrhage to preserve vision. Given his history of previous headache, loss of libido, and erectile dysfunction, he likely had a preexisting prolactinoma that acutely bled. Prolactinomas are almost always treated with dopamine agonists, but this patient requires urgent surgery to decrease pressure on the optic chiasm to save his vision. Transsphenoidal resection is the preferred method of pituitary surgery. He also requires urgent stress-dose glucocorticoids because of risk of secondary cortisol deficiency, which would be life-threatening.

The patient has appropriately received glucocorticoids for possible adrenocorticotropic hormone deficiency. There is no indication to assess other pituitary function. In the next 2 to 4 weeks, thyroid function will need to be assessed, but thyroxine (T₄) has a long half-life and does not need to be emergently measured or replaced. Treatment of hypogonadism or growth hormone deficiency is not urgent; surgical decompression is.

Waiting 2 weeks to repeat imaging could lead to permanent vision loss. He needs immediate intervention to preserve his vision. Similarly, whole brain external beam radiation is not appropriate for this patient who needs rapid surgical decompression.