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December 1992

Pituitary Apoplexy Precipitating Acute Angle Closure

Author Affiliations

Gainesville, Fla

Arch Ophthalmol. 1992;110(12):1687-1688. doi:10.1001/archopht.1992.01080240025017

Glaucoma pituitary apoplexy is typically heralded by the onset of severe headaches along with a variable combination of impaired vision, ophthalmoplegia, and endocrinologic dysfunction.1 We describe a patient who developed angle closure glaucoma presumably precipitated by mydriasis accompanying apoplexy-induced oculomotor palsy.

Report of a Case.  —A 47-year-old woman developed sudden severe headaches followed 3 hours later by diplopia. Examination revealed visual acuities of 20/200 in the right eye and counting fingers in the left eye. There were complete palsies of the left cranial nerves III, IV, and VI. Magnetic resonance imaging revealed a large mass within an expanded left hemisella, with erosion into the left sphenoid sinus and cavernous sinus (Figure). A presumptive diagnosis of pituitary apoplexy was made. Following transsphenoidal resection of the mass, the results of pathologic examination showed a necrotic, corticotropin-producing pituitary adenoma.On the first postoperative day, a complete left ophthalmoplegia was again noted. The

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