A 64 years old female presented with frontal headache and sinusitis like features. Later she got double vision when she woke up in the morning. No eye pain or vision loss. No weakness in the limbs. No neck pain. On examination: BP, heart rate and other observations within normal limits. No postural hypotension. Diplopia on left lateral gaze, very limited abduction of left eye. Other cranial nerves intact. Normal visual fields. No signs of Cushings. No motor or sensory deficit. No signs of meningism. CT head showed pituitary adenoma and then Pituitary MRI revealed 11 mm Pituitary macroadenoma with extension into left posterior aspect of cavernous sinus. Short synacthen test showed normal response. Prolactin, thyroid functions within normal limits. FSH, LH elevated appropriately for post-menopausal state. Vacuitis screen negative, HbA1C 38. It is unusual for Pituitary adenoma to involve Abducens nerve and spare other cranial nerves in the cavernous sinus. Pituitary adenoma is non functioning in this case but question is if this patient needs pituitary surgery if Abducens nerve paresis is due to Pituitary adenoma.