title: Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report.
abstract: BACKGROUND
  Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy.
  
  
  METHODS
  A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation.
  
  
  CONCLUSIONS
  This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.
authors.affiliation: Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Saffra
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kaplow
authors.forename: Irina
authors.initials: I
authors.lastname: Mikolaenko
authors.forename: Alice
authors.initials: A
authors.lastname: Kim
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rubin
authors.forename: Jafar
authors.initials: J
authors.lastname: Jafar
mesh_terms: D020434:Abducens Nerve Diseases / Q000209:etiology*; D000236:Adenoma / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D012507:Sarcoidosis / Q000150:complications; D013100:Sphenoid Bone / Q000601:surgery; D020521:Stroke / Q000150:complications
chemical_list: D000324:Adrenocorticotropic Hormone