Endocrine Abstracts

Primary hypophysitis (PH) is a rare clinical entity usually presenting with headaches, pituitary deficiency, visual field defects and exceptionally with symptoms of cavernous sinus infiltration such as cranial nerve palsies. An internal carotid artery (ICA) occlusion is unusual complication of PH infiltrating the cavernous sinus. A 32-year old woman presented with a 4-year history of recurring headaches, right retro-orbital pain, periodic diplopia and secondary adrenal insufficiency. She was admitted to the Department of Endocrinology due to deteriorating headaches, right retro-orbital pain, symptoms of the rightsixthcranial nerve palsy and secondary amenorrhea. Hormonal test results revealed panhypopituitarism. MRI scan showeda sellar and suprasellar mass infiltrating the right cavernous sinus. Additionally, a complete occlusion of right ICA was visible which was confirmed by CT-angiography. No other neurological symptoms were present. Based on clinical presentation, results of hormonal tests and MRI the diagnosis of PH was established. High-dose glucocorticosteroids (GCs) treatment was initiated, which resulted in the headaches and retro-orbital pain remission, abducens nerve palsy subsiding and return of regular menses. The patient has been treated for 10 months with a gradual reduction of GCs dose. A partial regression of parasellar infiltration was revealed on MRI scans but ICA occlusion seems to be permanent. Experience in treatment of PH with ICA occlusion is sparse. Similarly, to a few cases published in the literature, in our patient GCs therapy was not successful in restoring blood flow inthe affected ICA, although it improved pituitary function and reduced cranial nerve palsy and headaches.