ODP326 Isolated Abducens Palsy as a Presenting Feature of Pituitary Apoplexy

Abstract

Abstract Case Presentation A 27-year-old female with a history of T1DM presented to the ED for continued visual changes onset the past 10 days. The patient states that she was driving from Wisconsin to Arizona when she developed blurry vision localized to her right eye. She was previously evaluated by outpatient ophthalmology where she was diagnosed with R abducens palsy with no evidence of retinopathy. Associated symptoms included nausea, dizziness, and right sided HA localized behind her right eye and the base of her head. This HA was not relieved by Excedrin or Tylenol. Over the past 3 months, her menstrual periods have been lighter and irregular. Additionally, she has been lactating ever since the birth of her child 2.5 years ago. Hospital Course: Pt had stable vitals: T: 36.4 C, HR: 97, BP: 130/76, RR: 23, SPO2: 100%. Physical exam was WNL other than CN6 palsy. Lab workup was notable for: Na: 138, Cr: 1. 02. FT4 0.94, TSH 3.281, AM Cortisol 8.5, Random Cortisol 7.5, FSH 3.4, FG Glucose 329, and Prolactin 60.4. An MR Brain with and without contrast revealed an enlarged pituitary with a posterior 7mm lesion with small amount of hemorrhage given the high T1 signal. The patient was admitted for concerns of apoplexy and started on Hydrocortisone 50mg IV q12 x2 followed by Hydrocortisone 15mg qAM and 5mg qPM. 18 units of Lantus were started q24 hours along with Cabergoline 0.5mg tabs qhs Wednesday and Sunday. Discussion Pituitary Apoplexy is an endocrine emergency characterized by cortisol levels insufficient for normal body homeostasis. However, not all presentations of Apoplexy are typical. This case highlights isolated abducens palsy as the presenting feature of pituitary apoplexy. Due to the nature of the anatomy of the cavernous sinus, ocular palsies can be a simple physical findings that may have important clinical correlates that should be investigated further. Presentation: No date and time listed