Painful oculomotor nerve palsy due to lymphocytic hypophysitis

Painful oculomotor nerve palsy due to lymphocytic hypophysitis A 40-year-old man developed headache and a left oculomotor nerve palsy. MRI revealed diffuse enlargement of the pituitary gland and thickening of the pituitary stalk with strong gadolinium enhancement (figure). CSF examina-tion showed a lymphocytic pleocytosis; there were laboratory findings of panhypopituitarism, but no related symp-toms. We administered IV methylprednisolone. The headache and ophthalmoplegia showed a dramatic response, resolving 5 days later. Lymphocytic hypophysitis is characterized by autoimmune inflammation of the pituitary gland,1 usually presenting with headache and visual disturbances in women, rarely with oculomotor nerve palsy.1,2 Glucocorticoids effectively reduce inflammation and support adrenal function