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Internal Medicine
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Case Report
Abstract
Introduction: Hypopituitarism results from insufficient pituitary hormone production, often due to adenomas—accounting for ~15% of intracranial tumors. Non-functional adenomas, typically affecting older adults, may present with visual field deficits, headaches, or cranial nerve palsies when extending into the cavernous sinus. Isolated oculomotor (third nerve) palsy is a rare initial manifestation.
Case: A 46-year-old man with uncontrolled type 2 diabetes presented with acute right-sided headache, diplopia, ptosis, and right leg weakness. He had right ptosis, a fixed dilated pupil, facial droop, and right leg weakness. Given concern for stroke, he received thrombolytic therapy with partial leg improvement, but persistent diplopia and eye pain.
CT ruled out acute ischemia or hemorrhage but showed a sellar mass. MRI confirmed a 2.1 cm pituitary tumor compressing the optic chiasm and invading the right cavernous sinus. Labs revealed hypopituitarism: low cortisol (4.1 µg/dL), TSH (0.196 µIU/mL), free T4 (0.64 ng/dL), LH (0.4), prolactin (0.9 ng/mL), IGF-1 (68 ng/mL), and growth hormone (0.1 ng/mL), with HbA1c of 11.1%.
He was started on hydrocortisone, levothyroxine, insulin, and atorvastatin. Neurosurgery advised delayed resection after stabilization; endocrinology follow-up was arranged.
Discussion: This case underscores the importance of considering pituitary adenomas in patients with isolated cranial nerve deficits. A broad differential and early imaging are crucial to avoid misdiagnosis, especially in atypical presentations of non-functional pituitary tumors.
Presentation Type
Poster
Recommended Citation
Aboytes, Jorge A.; Loayza, Jose J.; Mogollon, Ivan; and Cantu, Ismael, "A Rare Sight: Isolated Third Nerve Palsy as the Sole Presentation of a Non-Functional Pituitary Adenoma" (2026). Research Colloquium. 117.
https://scholarworks.utrgv.edu/colloquium/2025/posters/117
A Rare Sight: Isolated Third Nerve Palsy as the Sole Presentation of a Non-Functional Pituitary Adenoma
Introduction: Hypopituitarism results from insufficient pituitary hormone production, often due to adenomas—accounting for ~15% of intracranial tumors. Non-functional adenomas, typically affecting older adults, may present with visual field deficits, headaches, or cranial nerve palsies when extending into the cavernous sinus. Isolated oculomotor (third nerve) palsy is a rare initial manifestation.
Case: A 46-year-old man with uncontrolled type 2 diabetes presented with acute right-sided headache, diplopia, ptosis, and right leg weakness. He had right ptosis, a fixed dilated pupil, facial droop, and right leg weakness. Given concern for stroke, he received thrombolytic therapy with partial leg improvement, but persistent diplopia and eye pain.
CT ruled out acute ischemia or hemorrhage but showed a sellar mass. MRI confirmed a 2.1 cm pituitary tumor compressing the optic chiasm and invading the right cavernous sinus. Labs revealed hypopituitarism: low cortisol (4.1 µg/dL), TSH (0.196 µIU/mL), free T4 (0.64 ng/dL), LH (0.4), prolactin (0.9 ng/mL), IGF-1 (68 ng/mL), and growth hormone (0.1 ng/mL), with HbA1c of 11.1%.
He was started on hydrocortisone, levothyroxine, insulin, and atorvastatin. Neurosurgery advised delayed resection after stabilization; endocrinology follow-up was arranged.
Discussion: This case underscores the importance of considering pituitary adenomas in patients with isolated cranial nerve deficits. A broad differential and early imaging are crucial to avoid misdiagnosis, especially in atypical presentations of non-functional pituitary tumors.
