Case: A 28-year old man was admitted to our hospital with complaints of three days of severe headache, diplopia and ptosis of the right eye. He had pituitary macroadenoma and had been on cabergolin 0.25 mg/week for the last six months. At physical examination, he demonstrated ptosis and inability to move the right eye medially. Magnetic resonance imaging showed a 13×12 mm pituitary mass with suprasellar extension and hemorrhage. Visual field analysis was abnormal except the lateral movement of the right eye. Laboratory hormonal analysis showed mild cortisol deficiency only. According to clinical, radiological and laboratory results, he was diagnosed as non-functional pituitary adenoma with apoplexy and III.cranial nerve palsy due to increased intrapituitary pressure. Intravenous methyl-prednisolone was started and symptoms resolved. One month after discharge, although he was using methyl prednisolone 4 mg, he was again admitted with complaints of nausea, vomiting, hypotension and ptosis. He was immediately taken to pituitary surgery via transnasal-transsphenoidal approach. His complaints dissolved following the procedure and he was well at discharge. Histopathological analysis of the operation specimen exhibited a pituitary adenoma with necrosis and hemorrhage. On the fifth postoperative day, he was re-admitted with diplopia, photophobia, phonophobia, nausea and vomiting. Recurrent headache attacks lasting for about one week within the last 6 months reminded accompanying ophtalmoplegic migraine. Eighty mg eltriptan and parenteral pulse steroid (1000 mg methyl prednisolone/5 days) were started. The patient had no longer experienced an attack.
Conclusion: Pituitary apoplexy and ophtalmoplegic migraine are rare clinical entities. Ophthalmoplegic migraine has been recognized as a cranial neuralgia and characterized by repetitive III, IV and / or VI. cranial nerve palsies. If there is persistent headache and cranial nerve palsies following surgical decompression of an adenoma with pituitary apoplexy, accompanying ophtalmoplegic migraine should be kept in mind.
20 - 23 May 2017
European Society of Endocrinology