Recurrent Lymphocytic Hypophysitis Presenting as Internal Carotid Artery Stenosis and Oculomotor Nerve Palsy

Intern Med. 2024 Jun 1;63(11):1623-1625. doi: 10.2169/internalmedicine.2674-23. Epub 2023 Oct 6.

Abstract

A 75-year-old woman presented with nausea and vomiting. Magnetic resonance imaging (MRI) revealed that she had a pituitary mass. A biopsy revealed lymphocytic hypophysitis (LYH). Symptoms were improved by hormone replacement therapy. Although she was asymptomatic, follow-up MRI revealed an increase in the size of the mass. Intravenous methylprednisolone (IVMP) reduced the size of the mass; however, right ophthalmalgia and oculomotor nerve palsy developed. MRI showed that the pituitary mass had enlarged to the right oculomotor nerve in the cavernous sinus and to the right internal carotid artery (ICA), causing stenosis of the ICA. After IVMP administration, the symptoms dramatically improved, but ICA stenosis persisted.

Keywords: internal carotid artery stenosis; lymphocytic hypophysitis; oculomotor nerve palsy.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Autoimmune Hypophysitis* / complications
  • Autoimmune Hypophysitis* / diagnosis
  • Autoimmune Hypophysitis* / drug therapy
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / pathology
  • Carotid Stenosis* / complications
  • Carotid Stenosis* / diagnosis
  • Carotid Stenosis* / diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Methylprednisolone* / administration & dosage
  • Methylprednisolone* / therapeutic use
  • Oculomotor Nerve Diseases* / diagnosis
  • Oculomotor Nerve Diseases* / etiology
  • Recurrence

Substances

  • Methylprednisolone