A 45-Year-Old Man With Progressive Vision Loss in One Eye

Carlo R. Bernardino, MD


February 19, 2014


A midline intracranial tumor often presents with a bitemporal visual field defect because of its ability to encroach or invade the optic nerve chiasm. Neuroimaging is key to determining the cause of the bitemporal visual field defect.

In this case, a pituitary tumor was identified. Pituitary adenomas are categorized based on size. A tumor smaller than 10 mm is called a microadenoma and one 10 mm or larger is a macroadenoma.

After diagnosis by imaging, patients should have basal hormone levels evaluated. In particular, if prolactin is elevated, these prolactin-secreting tumors can often be treated medically with dopaminergic agonists, such as bromocriptine or cabergoline.[1]

Other types of macroadenomas are treated with surgery[2] (often transsphenoidal) or radiation therapy.[3] Both surgery and radiation therapy have a significant risk of worsening vision, owing to the proximity of the optic nerve chiasm.

This patient was referred to a neurosurgeon for further evaluation and treatment.


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