title: Radiation-induced ocular motor cranial nerve palsies in patients with pituitary tumor.
abstract: BACKGROUND
  Radiation therapy is often used in the treatment of pituitary tumor. Diplopia due to radiation damage to the ocular motor cranial nerves has been infrequently reported as a complication in this clinical setting.
  
  
  METHODS
  Retrospective case series of 6 patients (3 men and 3 women) with pituitary adenoma, all of whom developed diplopia following transsphenoidal resection of pituitary adenoma with subsequent radiation therapy. None had evidence of tumor involvement of the cavernous sinus.
  
  
  RESULTS
  Five patients developed sixth nerve palsies, 3 unilateral and 2 bilateral, and in 1 patient, a sixth nerve palsy was preceded by a fourth cranial nerve palsy. One patient developed third nerve palsy. Five of the 6 patients had a growth hormone-secreting pituitary tumor with acromegaly. Following transsphenoidal surgery in all 6 patients (2 had 2 surgeries), 4 had 2 radiation treatments consisting of either radiosurgery (2 patients) or external beam radiation followed by radiosurgery (2 patients).
  
  
  CONCLUSIONS
  Patients with pituitary tumors treated multiple times with various forms of radiation therapy are at risk to sustain ocular motor cranial nerve injury. The prevalence of acromegalic patients in this study reflects an aggressive attempt to salvage patients with recalcitrant growth hormone elevation and may place the patient at a greater risk for ocular motor cranial nerve damage.
authors.affiliation: Department of Ophthalmology, University of Alabama, Suite 601, 700 South 18th Street, Birmingham, AL 35233, USA. vaph@uab.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Vaphiades
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Spencer
authors.forename: Kristen
authors.initials: K
authors.lastname: Riley
authors.forename: Courtney
authors.initials: C
authors.lastname: Francis
authors.forename: Luke
authors.initials: L
authors.lastname: Deitz
authors.forename: Lanning B
authors.initials: LB
authors.lastname: Kline
mesh_terms: D000328:Adult; D004172:Diplopia / Q000209:etiology; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000209:etiology / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015840:Oculomotor Nerve Diseases / Q000209:etiology*; D010291:Paresis; D010911:Pituitary Neoplasms / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D015175:Prolactinoma / Q000209:etiology* / Q000532:radiotherapy / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies