Unilateral total ophthalmoplegia without visual loss as the presenting form of a pituitary apoplexy.

Pituitary apoplexy (PA) is a potentially life-threatening disorder caused by acute ischemic infarction or haemorrhage of a pituitary adenoma. Although certain degree of ocular palsy is usually present, total ophthalmoplegia is an uncommon form of presentation, moreover with spared visual acuity. We report the case of a 70-year-old man who presented with retro-orbitary headache and progressive total right ophthalmoplegia with preserved visual function. MRI study revealed a pituitary mass with hyperintense T1 foci inside and postgadolinium enhancement that extended towards both cavernous sinuses. Laboratory tests showed a partial pituitary failure. Corticosteroid replacement was started before a trans-sphenoidal resection of the mass was done. Histopathology analysis was consistent with a pituitary adenoma. One week after intervention only a subtle defect for abduction of the right eye was present. PA should be considered when attending patients with ophthalmoplegia, and acute retroocular headache. A multidisciplinary approach must be rapidly done in order to solve hormonal dysfunction and preserve visual function. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Citation

M Delgado-Alvarado, J Riancho, L Riancho-Zarrabeitia, M J Sedano, J M Polo, J Berciano. Unilateral total ophthalmoplegia without visual loss as the presenting form of a pituitary apoplexy. Revista clinica espanola. 2013 Jul 16

PMID: 23870170

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