Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium.
Indian J Ophthalmol. 2011 Nov-Dec;59(6):517-9. doi: 10.4103/0301-4738.86330.
A 45-year-old man presented with binocular diplopia in primary gaze for 1 year. Orthoptic evaluation showed 10-prism diopter right eye hypotropia and 6-prism diopter right eye esotropia. The elevation and abduction of the right eye were mechanically restricted. This was associated with systemic features suggestive of acromegaly. Magnetic resonance imaging (MRI) of the brain demonstrated a pituitary macroadenoma. An elevated serum insulin-like growth factor I level and the failure of growth hormone suppression after an oral glucose load biochemically confirmed the diagnosis of acromegaly. Computed tomography (CT) of the orbit demonstrated bilateral symmetrical enlargement of the medial rectus and inferior rectus muscle bellies. All tests regarding Graves-Basedow disease were negative. Although rare, diplopia due to a restrictive extraocular myopathy could be the presenting symptom of acromegaly.
一位 45 岁男性，1 年来主觉复视，双眼同时注视时复视。斜视检查发现右眼 10 棱镜度下斜视和 6 棱镜度外斜视。右眼上、下转均受限，且伴有全身表现，提示肢端肥大症。颅脑磁共振成像（MRI）显示垂体大腺瘤。血清胰岛素样生长因子 I 水平升高，口服葡萄糖负荷后生长激素抑制失败，生化检查确诊为肢端肥大症。眼眶 CT 显示双侧内直肌和下直肌腹对称性增大。所有格雷夫斯病相关检查均为阴性。尽管罕见，但限制性眼外肌病引起的复视可能是肢端肥大症的首发症状。
