Complete and Uneventful Recovery in a Case of Lymphocytic Hypophysitis Causing a Third Nerve Palsy

ABSTRACT

Lymphocytic hypophysitis (LH) is a neuroendocrine disorder characterised by autoimmune inflammation of the pituitary gland with resultant pituitary dysfunction. Rarely, the presenting symptom can be diplopia due to irritation of the third, fourth, or sixth cranial nerves secondary to cavernous sinus involvement of the mass or increased intracranial pressure. We describe the case of a healthy, 20-year-old female with a pupillary sparing third nerve palsy, who was subsequently diagnosed with LH after an endoscopic transsphenoidal biopsy of the mass. She was treated with hormone replacement therapy and corticosteroids, resulting in full resolution of symptoms with no recurrence to date. To our knowledge, this is the first report of a third nerve palsy due to definitive biopsy proven LH. Despite its rarity, the unique presentation and favourable evolution of this case should aid clinicians in its timely recognition, appropriate workup, and treatment.

KEYWORDS:

• Lymphocytic hypophysitis
• corticosteroids
• oculomotor nerve palsy
• third nerve palsy
• resolution

Acknowledgements

We would like to acknowledge Dr. Jared Steinklein MD, the attending radiologist on this case, who assisted us in obtaining the relevant imaging for this case report. We would also like to acknowledge Dr. Jian Yi Li MD, the attending pathologist on this case, who assisted us in obtaining the relevant slides for this case report.

Authors’ contributions

J.M.N. and P.P.S. wrote the main manuscript text and prepared Figures 1–4. R.V. supervised all revisions and editing of the manuscript. J.M.N., P.P.S., and R.V. reviewed and approved the final version of the manuscript.

Ethics approval

Ethics approval was not required as this was a retrospective case report.

Disclosure statement

No potential conflict of interest was reported by the authors.

Consent for publication

Consent for publication was obtained from the patient.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article..