Sudden death from pituitary apoplexy in a patient presenting with an isolated sixth cranial nerve palsy.
A 68-year-old diabetic, hypertensive man presented with a left sixth cranial nerve palsy. MRI demonstrated an inhomogeneous sellar mass encroaching on the left cavernous sinus. Two days later, a left third cranial nerve palsy developed. Within 24 hours, the patient went into cardiac arrest and died. An autopsy showed hemorrhage within a pituitary macroadenoma ("pituitary apoplexy"). Pituitary apoplexy should be considered a cause of acute isolated sixth cranial nerve palsy and may represent a life-threatening emergency that can be averted with emergent hormonal replacement and hypophysectomy.
Warwar
Ronald E
RE
Department of Surgery, Kettering Medical Center, Dayton, Ohio, USA. rwarwar@warwareyegroup.com
Bhullar
Shaminder S
SS
Pelstring
Richard J
RJ
Fadell
Ronald J
RJ
D020434:Abducens Nerve Diseases / Q000150:complications* / Q000175:diagnosis; D000368:Aged; D003645:Death, Sudden / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis