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Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

An Uncommon Pituitary Macroadenoma

Written by Joyce Dapula, BS, Austin Yang, Chloe G. Hoag, RN, and Richard L. Rabin, MD. Photo by Richard L. Rabin, MD. All are at Walnut Creek Eye Care, Walnut Creek, Calif.

A 49-year-old man presented with a history of two months of temporal blurriness in his left eye. He described a vertical line down the center, splitting his vision between the normal (nasal) and abnormal (temporal) areas. BCVA was 20/20 in both eyes. The patient correctly identified the color vision testing plates with each eye. IOPs were normal. No afferent pupillary defect was present. The slit-lamp exam was unremarkable except for mild cataracts. The fundus exam was within normal limits, with a .3 cup-to-disc ratio and pink and sharp nerves in both eyes. OCT of the optic nerve was within normal limits for both eyes. 24-2 Humphrey visual fields (HVFs) showed a temporal peripheral and central defect in the left eye (Fig. 1) and a normal field in the right eye (Fig. 2). HVF 10-2 showed a central defect respecting the vertical meridian in the left eye (Fig. 3) and a normal right eye (Fig. 4). Contrast-enhanced fat-suppressed axial T2 (Fig. 5) and coronal STIR (Fig. 6) brain magnetic resonance imaging revealed a 22 × 19 × 24 mm macroadenoma in the sella turcica extending superiorly and compressing the optic chiasm.

The patient underwent a transsphenoidal pituitary resection to remove the mass, and the field defect completely resolved.

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