Myasthenia Gravis Mimicking Third Cranial Nerve Palsy: a Case Report

  • Sardar Ali Khan Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Waqas Shafiq Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Umal Azmat Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Ahmed Imran Siddiqi Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Waqas Ahmad Department of Radiology, Shaukat Khanum Memorial Cancer hospital and Research Centre, Lahore
Keywords: Myasthenia gravis, pituitary adenoma, third cranial nerve palsy

Abstract

Background: The most common pituitary adenoma presentation is a visual field defect and inappropriate pituitary hormone secretion. The compression of the optic chiasma causes visual impairment. Large pituitary adenomas can rarely cause diplopia and ptosis secondary to adenoma's lateral extension into the cavernous sinus. Myasthenia gravis (MG) is an autoimmune disorder involving neuromuscular junctions. It is characterized by skeletal muscle fatigability, commonly involving extraocular muscles, face, and limbs. It is estimated that 75% of MG patients present with ptosis and diplopia. The association of MG with pituitary adenoma is very rare. Case Description: A 30-year-old lady presented with headache, diplopia, and ptosis of the left eye for two months. She was diagnosed with acromegaly secondary to pituitary adenoma. Ptosis is a rare presenting feature in pituitary adenoma. Her case was discussed in a multidisciplinary meeting, and the consensus was that her ptosis is likely secondary to pituitary adenoma, which was involving the left cavernous sinus. She underwent transsphenoidal resection of pituitary macro adenoma. Three weeks post-surgery, she developed bilateral ptosis, dysarthria, dysphonia, which was diagnosed as myasthenia gravis. Clinical implications: Ptosis is a rare manifestation of pituitary adenoma. Nonetheless, pituitary tumor patients presenting with ptosis should be evaluated for the neuromuscular disorder. A high index of suspicion is required for early diagnosis and prompt treatment of myasthenia gravis.

Published
2021-01-11
How to Cite
1.
Khan SA, Shafiq W, Azmat U, Siddiqi AI, Ahmad W. Myasthenia Gravis Mimicking Third Cranial Nerve Palsy: a Case Report. J Cancer Allied Spec [Internet]. 2021Jan.11 [cited 2021May13];7(1). Available from: https://journals.sfu.ca/jcas/index.php/jcas/article/view/391