Abrupt-onset oculomotor paralysis: an endocrine emergency

Abstract

Pituitary apoplexy is a severe and potentially life-threatening condition that may be highly variable in its clinical presentation. We report a 37-year-old man presenting to the emergency department with diplopia that abruptly developed while he was eating canned and bottled food prepared at home. A computed tomography scanning revealed an isodense mass within the sellar region and, subsequently, a magnetic resonance imaging showed a pituitary apoplexy causing a compression of the right III and VI oculomotor nerves. There was no improvement with hydrocortisone therapy and the patient underwent a transsphenoidal excision of the mass with an uneventful course. Pituitary apoplexy may raise in the appropriate setting the suspicion of botulism. The abrupt-onset paralysis of oculomotor nerves has been described as the chief presenting sign of pituitary apoplexy in only few cases including this. A pathophysiology, differential diagnosis with botulism and other causes of multiple cranial nerve paralysis, and treatment are described.

Complete Surgical Resolution of Bilateral Total Opthalmoplegia without Visual Field Defect in an Acromegalic Patient Presented with Pituitary Apoplexy

“…The cranial nerves III, IV, V, and VI can be compressed due to PA. As a result, certain degree of ocular palsy is present in 40% of patients which may be unilateral or bilateral [11,12]. Isolated opthalmoplegia without loss of vision as seen in this case is very rarely the presenting sign of a pituitary adenoma or PA.…”

“…Opthalmoplegia may occur slowly as a result of mechanical compression or rapidly due to PA as in the present case. Cranial nerves III, IV, and VI may be entrapped in the cavernous sinus by an expanding hematoma, thus may cause various degrees of opthalmoplegia, ptosis, and pupillary defects [11,12]. If diagnosed correctly and treated either medically or surgically, opthalmoplegia secondary to PA appears to be reversible.…”

“…Abrupt onset oculomotor nerve paralysis and decreased visual acuity and/or visual field defects may be the presenting features of PA [11]. However, oculomotor nerve paralysis without visual field defect is very rare in patients with PA and has been previously reported in a few cases as the presenting feature [11][12][13][14].…”

“…However, oculomotor nerve paralysis without visual field defect is very rare in patients with PA and has been previously reported in a few cases as the presenting feature [11][12][13][14].…”

Pituitary Apoplexy due to Prolactinoma in a Taiwanese Boy: Patient Report and Review of the Literature

“…Preoperative endocrine evaluation revealed the following: elevated prolactin (PRL) 747 ng/ml (normal range 3-18), low free thyroxine (T4) 0.69 ng/dl (0.8-2.2), low T 4 3.2 ng/dl (4.9-13), triiodothyronine (T 3 ) 104 ng/dl (80-185), thyroidstimulating hormone (TSH) 1.81 μΐυ/ml (0.6-5.5), LH <0.5 mIU/ml (0.4-7.1), follicle-stimulating hormone (FSH) 0.93 mIU/ml (2.0-9.2), testosterone 0.12 ng/ml (3.5-9.7), and Cortisol 1.81 ng/dl (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Bone age was 14 years 7 .…”