Akram A, Raja N, Ishaq M, Farooq, Azad N.
Pituitary Adenoma presenting as un-explained Visual Loss.
Pak J Surg Jan ;18(2):40-2.

This patient was referred by an ophthalmologist from a peripheral hospital. The referral note mentioned that the patient who was a thirty year old female was suffering from progressive visual loss and that the visual loss was unexplained since there was no significant refractive error. Fundus examination showed `normal` discs and maculae. Upon re-evaluating the case the lady complained of progressive visual loss for the past few months. She had been suffering from marked headache on and off for the past three to four years. She had a CT SCAN of brain done a couple of years ago which was reported normal. On detailed inquiry she disclosed that she had amenorrhea for the past eight months and was also seen by a consultant physician for suspected endocrinal abnormalities. She had not been on any regular medication apart from taking occasional painkillers for headache. Ophthalmic examination revealed visual acuity of 6/12 in right eye and hand movement perception in left eye with no improvement with pinhole. There was no significant refractive error. A relative afferent pupillary defect in the left eye was present. The colour vision in the right eye was normal. The left colour vision could not be checked. Intraocular pres-sure was normal in both eyes. The fundus examination showed normal maculae and periphery. The discs initially appeared normal but careful examination by multiple ophthalmologists revealed that there was some element of temporal pallor in the left optic disc, the amount of pallor of which did not correlate to the drastic visual loss. The right disc appeared normal. A 30-2 computerized visual field done revealed dramatic results. Keeping in view the visual field changes with a history of amenorrhea we reached a provisional diagnosis of a pituitary tumor most probably a prolactinoma. A CT scan of brain confirmed the presence of a pituitary tumour, which was later removed by neurosurgeons. The lady is presently fit and healthy and regularly being followed up by a consultant physician to deal with the endocrine aspect of the problem. There was about 30% improvement in the visual field of left eye performed three months after surgery. No improvement in the visual field of right eye was appreciated.

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