Pituitary Apoplexy Presenting With Oculomotor Nerve Palsy and Headache as the Initial Symptoms: A Case Report

Pituitary apoplexy is a rare clinical syndrome. This report presents a case with initial symptoms of oculomotor nerve palsy and headache. A 48-year-old patient reported blurred vision in the right eye for 1 month, followed by a sudden onset of left eyelid ptosis and a 1-day headache. Laboratory tests revealed normal pituitary function, except for an elevated growth hormone level (> 36.600 μg/L). Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans indicated space-occupying lesion in the sellar region. The lesion was subsequently resected via transnasal subtotal surgery. Histopathological and immunohistochemical analyses confirmed a pituitary adenoma with infarction. The patient received hydrocortisone preoperatively and prednisone and levothyroxine postoperatively. On the second postoperative day, the headache resolved, and the left eyelid regained normal function within 2 weeks. Pituitary apoplexy is extremely rare, with initial presentations of oculomotor nerve palsy being exceptionally uncommon. Early diagnosis and prompt surgical intervention are essential to preserve pituitary function and rapidly alleviate cranial nerve dysfunction.