Email updates

Keep up to date with the latest news and content from BMC Ophthalmology and BioMed Central.

Open Access Highly Accessed Case report

Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report

Norman Saffra12, Elizabeth Kaplow3*, Irina Mikolaenko4, Alice Kim2, Benjamin Rubin5 and Jafar Jafar5

Author Affiliations

1 Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY, USA

2 Department of Ophthalmology, Maimonides Medical Center, Brooklyn, New York, USA

3 Mount Sinai School of Medicine, New York, NY, USA

4 Department of Pathology, Division of Neuropathology, New York University, New York, NY, USA

5 Department of Neurosurgery, New York University Langone Medical Center, New York, NY, USA

For all author emails, please log on.

BMC Ophthalmology 2011, 11:4  doi:10.1186/1471-2415-11-4

Published: 27 January 2011

Abstract

Background

Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy.

Case Presentation

A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation.

Conclusions

This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.