Case 135 -- Progressive Visual Deficits

Contributed by Charles A. Richert, M.D.1, John E. Sheaffer1, Hae Dong Jho, M.D.3 and Ronald L. Hamilton, M.D.2
Departments of Pathology1 (Division of Neuropathology2) and Neurosurgery3, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A.
Published on line in March 1998


An 82-year-old Caucasian male who developed visual problems in 1989 received a magnetic resonance (MR) scan which revealed a 2 cm pituitary adenoma. Endocrine testing revealed a high prolactin level and he was treated with bromocriptine resulting in a 10-fold decrease in the prolactin level and marked improvement in his visual symptoms. Repeat MR scanning in March, 1997 revealed a tumor that had doubled in size and the prolactin level had increased from an average of around 300 ng/ml to almost 1,000 ng/ml despite increased dosage of bromocriptine treatment. Due to clinical symptoms including complete loss of right eyesight and rapidly progressive deterioration of left eyesight, he elected to have surgical resection of the tumor performed through a right-sided endonasal approach. Most of the tumor was resected, but the rostral portion involving the cavernous sinus and dome of the tumor were kept intact to preserve pituitary gland function. Visual deficits were partially resolved postoperatively but returned in July, 1997 and progressed to near total blindness by September, 1997 when the patient underwent a right-sided endoscopic transsphenoidal pituitary resection.




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