Abrupt-onset oculomotor paralysis: an endocrine emergency.
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.
Famularo
G
G
Department of Medical Sciences, San Camillo Hospital, Rome, Italy.
Pozzessere
C
C
Piazza
G
G
De Simone
C
C
D000208:Acute Disease; D000328:Adult; D004172:Diplopia / Q000209:etiology* / Q000628:therapy; D004630:Emergencies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009886:Ophthalmoplegia / Q000209:etiology* / Q000628:therapy; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010911:Pituitary Neoplasms / Q000175:diagnosis; D015175:Prolactinoma / Q000175:diagnosis; D016896:Treatment Outcome