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

Yui Watanabe; Hiroyuki Maruoka; Hiroaki Yokote; Toshiki Uchihara; Shuta Toru

doi:10.2169/internalmedicine.2674-23

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

Intern Med. 2023 Oct 6. doi: 10.2169/internalmedicine.2674-23. Online ahead of print.

Authors

Yui Watanabe¹, Hiroyuki Maruoka¹, Hiroaki Yokote¹, Toshiki Uchihara¹, Shuta Toru¹

Affiliation

¹ Department of Neurology, Nitobe Memorial Nakano General Hospital, Japan.

PMID: 37813605
DOI: 10.2169/internalmedicine.2674-23

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.