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Temporary bilateral oculomotor nerve palsy as the sole presenting sign of a pituitary mass

A 65-year-old patient presented with isolated bilateral third nerve palsy. Neuroimaging demonstrated a 2 cm pituitary mass with extension into the cavernous sinus on the right. The patient went on to experience spontaneous complete resolution of symptoms with associated radiological shrinkage of the mass. Bilateral third nerve palsy is a very rare presenting sign, with only one previous case reported in the literature secondary to a pituitary adenoma. Spontaneous resolution of non-functioning pituitary tumours is reported to occur in approximately 10% of cases. However, there are only a small number of reports to date involving spontaneous regression of tumours with corresponding resolution of cranial nerve palsies.