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Bilateral Sixth Nerve Palsy: A Rare Presentation of Primary Hypophysitis
Josue D Pagoada-Torres1, Rodolfo Villalobos-Díaz2, Luz M Pineda-Centeno3
1Endocrinology, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, MEX.
Cureus
|May 24, 2024
Summary
This study presents a rare case of hypophysitis causing bilateral sixth nerve palsy and hypopituitarism. Steroid treatment led to significant improvement, highlighting its efficacy in managing this condition.
Area of Science:
- Neuroendocrinology
- Ophthalmology
Background:
- Cranial nerve palsy, particularly involving the sixth cranial nerve, is a known complication of pituitary gland diseases.
- Bilateral sixth nerve palsy is rare in pituitary pathologies, typically associated with pituitary apoplexy in adenomas or exceptionally in hypophysitis.
Observation:
- A 32-year-old female presented with headache, diplopia, bilateral sixth nerve palsy, and hypopituitarism.
- Magnetic resonance imaging (MRI) showed symmetric pituitary gland expansion with bilateral cavernous sinus invasion and pituitary stalk thickening, suggesting hypophysitis.
Findings:
- Intravenous methylprednisolone treatment resulted in a reduction of the pituitary lesion.
- Complete resolution of right eye sixth nerve palsy and partial improvement in the left eye were observed post-treatment.
Implications:
- This case highlights an uncommon presentation of hypophysitis.
- Early diagnosis and prompt treatment with corticosteroids are crucial for managing hypophysitis and reversing neurological deficits like cranial nerve palsy.
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