Isolated ophthalmoplegia should we think about pituitary apoplexy?

Abdelkader Yahi; Haffaf Lounes; Lachekham Aicha; Benabdellatif Katia; Longo Redoune; Derriche Abderrahim; Talbi A; Derradji Hakim; Ould-Kablia Samia; Bensalah Meriem

doi:10.1530/endoabs.99.EP1188

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Endocrine Abstracts (2024) 99 EP1188 | DOI: 10.1530/endoabs.99.EP1188

ECE2024 Eposter Presentations Pituitary and Neuroendocrinology (214 abstracts)

Isolated ophthalmoplegia should we think about pituitary apoplexy?

Abdelkader Yahi ¹ , Haffaf Lounes ¹ , Lachekham Aicha ¹ , Benabdellatif Katia ¹ , Longo Redoune ¹ , Derriche Abderrahim ¹ , Talbi A ¹ , Derradji Hakim ¹ , Ould-Kablia Samia ¹ & Bensalah Meriem ¹

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¹Algeria, Endocrinology Bir Mourad Rais

Background: Pituitary apoplexy (PA) is a rare neuroendocrine emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. We report a case of apoplexy manifesting with isolated ophtalmoplégia.

Case description: We report the case of a 48-year-old man with a history of hypertension, type 2 diabetes mellitus, and dyslipidemia. Consult a private ophthalmologist following the sudden appearance of double vision and sagging of the right upper eyelid. The ophthalmological examination revealed paralysis of the right common oculomotor nerve (3rd cranial nerve). The patient was placed on symptomatic treatment. A week later, given the worsening of the ptosis, a brain CT scan was requested, which revealed a tumor process in the sellar region with hemorrhagic changes. Hypothalamic-pituitary MRI revealed a hemorrhagic pituitary macroadenoma measuring 30 mm long axis. The diagnosis of pituitary apoplexy was made. Since the patient was scored 2 according to the Pituitary Apoplexy Score (PAS), he benefited from conservative treatment (corticotherapy) with complete recovery of the visual impairment. The morphological evaluation carried out at 3 months found a clear regression of the tumor volume with the persistence of a remainder of 11 mm.

Discussion: PA is an atypical condition. The incidence ranges from 2 to 10% of all pituitary adenomas (PITNET). Despite the best diagnostic and treatment conditions, morbidity and mortality remain high at 15.3%. Therapeutic management, particularly medical or surgical management, is still debated and remains at the discretion of the practitioner. The interest in the PituitaryApoplexy Score (PAS), rated from 0 to 10, was reported in the 2011 British consensus, without threshold established to guide management.

Conclusion: The study of this observation underlines the variable clinical presentation of pituitary apoplexy whose evolution is conditioned by early diagnosis and treatment making it possible to first preserve the vital prognosis, as well as the visual prognosis and prevent irreversible damage.