A 48-year-old woman with a history of prolactinoma managed with cabergoline presents with acute severe headache, bitemporal hemianopsia, and confusion. Vital signs show BP 148/92, HR 92, RR 18, temp 37.2°C, SpO2 98% on room air. MRI demonstrates rapid sellar mass enlargement with intrasellar hemorrhage and suprasellar extension compressing the optic chiasm. Serum sodium is 128 mEq/L. No focal neurologic deficits are noted. Which of the following is the most appropriate immediate management?

1. A)Hormone replacement therapy only
2. B)High-dose dopamine agonist therapy
3. C)Observation with serial imaging
4. D)Dexamethasone and supportive care
5. E)Emergent transsphenoidal decompressionGABARITO