Pituitary apoplexy presenting as unilateral third cranial nerve palsy after coronary artery bypass surgery.
The new onset of pituitary apoplexy is a rare perioperative complication of coronary artery bypass surgery. A variety of clinical presentations of pituitary apoplexy have been reported including absence of clinical symptoms or headache, sudden deterioration of mental status, visual changes, Addisonian crisis, and ophthalmoplegia, including third cranial nerve palsy and/or ptosis. Early diagnosis and treatment usually results in excellent outcome. We report a case of pituitary apoplexy that presented with only a unilateral dilated pupil, ptosis, and vision change within 3 h after coronary artery bypass surgery. The patient recovered fully after early pituitary tumor resection and hormonal therapy.


CONCLUSIONS
Unilateral pupil dilation is a rare perioperative complication after coronary artery bypass surgery. We report a case of pituitary apoplexy that presented clinically as unilateral dilated pupil, ptosis, and visual loss shortly after coronary artery bypass surgery.
Chen
Zongfu
Z
Department of Anesthesiology, University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.
Murray
Andrew W
AW
Quinlan
Joseph J
JJ
D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D001763:Blepharoptosis / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000139:chemically induced / Q000209:etiology*; D010899:Pituitary Apoplexy / Q000175:diagnosis / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D011680:Pupil / Q000187:drug effects