Complete Surgical Resolution of Bilateral Total Opthalmoplegia without Visual Field Defect in an Acromegalic Patient Presented with Pituitary Apoplexy

Endocrine Journal

Kursad UNLUHIZARCI¹  Ahmet SELCUKLU²  Fahrettin KELESTIMUR¹  Zuleyha KARACA¹  Ahmet Candan DURAK³  Ayse ONER⁴  Fatih TANRIVERDI¹ 

[1] Department of Endocrinology, Erciyes University Medical School;Department of Neurosurgery, Erciyes University Medical School;Department of Radiology, Erciyes University Medical School;Department of Ophthalmology, Erciyes University Medical School

关键词: Pituitary apoplexy;    Acromegaly;    Opthalmoplegia;    Hypopituitarism;   

DOI  :  10.1507/endocrj.K07-008

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(19)Cited-By(5)Pituitary apoplexy (PA), which is one of the most serious life-threatening complications of pituitary adenoma, is characterized by abrupt onset of headache, nausea, vomiting, visual disturbances and oculomotor paresis. Combination of oculomotor cranial nerve paralysis with normal visual fields is very rare in PA. We report a 60-year-old acromegalic man presented with panhypopituitarism and bilateral total opthalmoplegia without a visual field defect. At initial evaluation his clinical findings were compatible with adrenal crisis and eye examination revealed total opthalmoplegia, bilateral ptosis and normal vision. MRI showed a large heterogeneous mass in the pituitary fossa. Although clinical findings due to adrenal crisis improved after glucocorticoid therapy there was no improvement in opthalmoplegia and ptosis. The patient underwent transsphenoidal excision of the pituitary mass. Histological examination revealed an adenoma with large areas of hemorrhagic infarction and most of the cells were positive for GH in immunohistochemical analysis. Although opthalmoplegia was severe at presentation, total recovery was achieved 3 months after transsphenoidal surgery. Therefore the presented case clearly demonstrates that opthalmoplegia without a visual field defect due to PA has a good prognosis and early diagnosis and treatment including surgical decompression are crucially important.

【 授权许可】

Unknown