Endocrinology Question 19 Instructor

You are examining Alice Smith (with ?acromegaly).

How can a pituitary tumor affect the cranial nerves (list two mechanisms)? What cranial nerves can be affected?

Upward growth – affects the optic chiasm:

  • Cranial nerve II

Lateral growth into the cavernous sinuses:

  • Cranial nerves III, IV, V1, V2, VI

How do you examine the patient for damage to these nerves?

Cranial nerve II:

  • visual acuity
  • visual fields (including red pin) looking for bitemporal hemianopsia
  • PERLA (looking for RAPD)
  • fundoscopy (R/O optic disc pallor)

Cranial nerves III, IV, VI:

  • EOMS (diplopia)

Cranial nerve V1, V2:

  • sensation forehead and cheek
  • corneal reflex

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