Pituitary Apoplexy Presenting as Unilateral Oculomotor Palsy in a Patient with Diabetes Mellitus

Pituitary apoplexy is a clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. This study presents a case of a 53-year-old man with a seven-day history of severe headache and left-sided oculomotor palsy, who had pupil-sparing oculomotor palsy with a previous history of diabetes mellitus. Diabetes-related microvascular ischemia was initially considered due to the pupil sparing, before imaging studies. However, pituitary hemorrhage was detected adjacent to the ICA cavernous segment in cranial and pituitary MRI, identified as the cause of the oculomotor nerve palsy. This case is significant for highlighting pituitary apoplexy as a rare cause of oculomotor palsy without pupil involvement in patients with diabetes mellitus.