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Pituitary adenoma visual defects
Neuro-Ophthalmology
Key Points
- •Bitemporal hemianopia = chiasmal compression until proven otherwise - MRI with pituitary protocol is mandatory; most common cause is pituitary adenoma
- •Band (bow-tie) optic atrophy is pathognomonic of a chiasmal lesion - selective pallor of nasal and temporal disc sectors with preservation of superior and inferior sectors
- •Always check serum prolactin before surgery - a macroprolactinoma (prolactin ≥200 ng/mL) is the ONLY pituitary tumor where dopamine agonist (cabergoline) is first-line even with visual loss
- •Pituitary apoplexy is an emergency - give IV hydrocortisone 100 mg stat (do not wait for cortisol results) and arrange urgent transsphenoidal decompression if visual deterioration is progressive
- •Preoperative RNFL <50 μm on OCT predicts irreversible axonal loss and poor visual recovery after surgery - timing of intervention is critical
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations