Bilateral Sixth Nerve Palsy: A Rare Presentation of Primary Hypophysitis

Cranial nerve palsy is common in pituitary disease and depends on the extension of the lesion into the cavernous sinuses. Bilateral cranial nerve palsy was described in pituitary adenomas with apoplexy and in only one case in hypophysitis. We present a case of a 32-year-old female manifesting with h...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-04, Vol.16 (4), p.e58850
Main Authors: Pagoada-Torres, Josue D, Villalobos-Díaz, Rodolfo, Pineda-Centeno, Luz M, Pesci-Eguia, Luis, Gomez-Villegas, Thamar, Rivera-Montes, Hector, Portocarrero-Ortiz, Lesly A
Format: Article
Language:English
Subjects:
Biopsy
Case reports
COVID-19
Diabetes
Diplopia
Endocrinology/Diabetes/Metabolism
Etiology
Headaches
Hormones
Inflammatory diseases
Insulin-like growth factors
Magnetic resonance imaging
Neurological disorders
Neurology
Ophthalmology
Patients
Pituitary gland
Sinuses
Systematic review
Tumors
Citations: Items that this one cites
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Summary:Cranial nerve palsy is common in pituitary disease and depends on the extension of the lesion into the cavernous sinuses. Bilateral cranial nerve palsy was described in pituitary adenomas with apoplexy and in only one case in hypophysitis. We present a case of a 32-year-old female manifesting with headache, diplopia, bilateral sixth nerve palsy, and hypopituitarism. Magnetic resonance imaging (MRI) revealed symmetric expansion of the pituitary gland, with bilateral cavernous sinus invasion and thickening of the pituitary stalk. Hypophysitis was suspected, and after treatment with IV methylprednisolone boluses, a decrease in the pituitary lesion was observed, with complete remission of sixth nerve palsy in the right eye and partial improvement in the left eye. In this case, we report an infrequent form of presentation of hypophysitis, and highlight that steroids are the first line of treatment.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.58850