Pituitary Adenoma

  • An-Guor Wang


A 62-year-old female presented with complaints of blurred vision OU for 3 weeks. Her corrected vision was 6/8.6 in the right eye and 6/60 in the left. Intraocular pressure was 12 mmHg in both eyes. Anterior segment was normal OU. Fundoscopic examination showed a small patch of myelinated nerve fibers over the superior disc margin of the right eye (Fig. 41.1). OCT found nerve fiber loss in the naso-temporal sectors of both eyes, with an average peripapillary retinal nerve fiber layer (RNFL) thickness of 86 μm in the right eye and 67 μm in the left. Decreased thickness of the ganglion cell-inner plexiform layer (GC-IPL) was also noted over bilateral macular regions. There was a special pattern of binasal loss of the GC-IPL (Fig. 41.2), corresponding to bitemporal defects in the visual field (Fig. 41.3). MRI of the brain found a less enhanced lesion (27 × 29 × 26 mm) in the pituitary fossa and suprasellar cistern, compatible with pituitary adenoma (Fig. 41.4). The patient underwent endoscopic transsphenoidal surgery 2 weeks later, and the pathological report indicated gonadotroph adenoma. Prolactin was elevated with a concentration of 46.85 ng/ml (normal range for female: 1.2–29.93). At 15 months postoperatively, her corrected vision improved to 6/6.7 OD and 6/60 OS. However, the peripapillary RNFL and macular GC-IPL progressed to more severe conditions, especially in the left eye due to concurrent maculopathy (Fig. 41.5). The defective visual field also continued to deteriorate in the left eye (Fig. 41.6).


  1. 1.
    Muskens IS, Zamanipoor Najafabadi AH, Briceno V, Lamba N, Senders JT, van Furth WR, Verstegen MJT, Smith TRS, Mekary RA, Eenhorst CAE, Broekman MLD. Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis. Pituitary. 2017;20(5):539–52. Scholar
  2. 2.
    Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017;317(5):516–24.CrossRefPubMedGoogle Scholar
  3. 3.
    Fontana E, Gaillard R. Epidémiologie des adénomes hypophysaires [in French]. Rev Med Suisse. 2009;5(223):2172–4.PubMedGoogle Scholar
  4. 4.
    Fernandez A, Karavitaki N, Wass JA. Prevalence of pituitary adenomas. Clin Endocrinol. 2010;72(3):377–82.CrossRefGoogle Scholar
  5. 5.
    Raappana A, Koivukangas J, Ebeling T, Pirilä T. Incidence of pituitary adenomas in Northern Finland in 1992–2007. J Clin Endocrinol Metab. 2010;95(9):4268–75.CrossRefPubMedGoogle Scholar
  6. 6.
    Gruppetta M, Mercieca C, Vassallo J. Prevalence and incidence of pituitary adenomas: a population based study in Malta. Pituitary. 2013;16(4):545–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Tjörnstrand A, Gunnarsson K, Evert M, et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011. Eur J Endocrinol. 2014;171(4):519–26.CrossRefPubMedGoogle Scholar
  8. 8.
    Agustsson TT, Baldvinsdottir T, Jonasson JG, et al. The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study. Eur J Endocrinol. 2015;173(5):655–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Laws ER, Thapar K Jr. Pituitary surgery. Endocrinol Metab Clin N Am. 1999;28(1):119–31.CrossRefGoogle Scholar
  10. 10.
    Molitch ME. Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin N Am. 2008;37(1):151–71.CrossRefGoogle Scholar
  11. 11.
    Okamoto Y, Okamoto F, Hiraoka T, Yamada S, Oshika T. Vision-related quality of life in patients with pituitary adenoma. Am J Ophthalmol. 2008;146(2):318–22.CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang L, Sun C, Sun X. The clinical features and value of macular ganglion cell complex thickness patterns in patients with optic chiasma lesion. Zhonghua Yan Ke Za Zhi. 2016;52(5):335–42.PubMedGoogle Scholar
  13. 13.
    Johnston PC, Hamrahian AH, Weil RJ, Kennedy L. Pituitary tumor apoplexy. J Clin Neurosci. 2015;22(6):939–44.CrossRefPubMedGoogle Scholar
  14. 14.
    Choi SH, Kwon BJ, Na DG, Kim JH, Han MH, Chang KH. Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: differentiation using MRI. Clin Radiol. 2007;62(5):453–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Casanueva FF, Molitch ME, Schlechte JA, et al. Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas. Clin Endocrinol. 2006;65(2):265–73.CrossRefGoogle Scholar
  16. 16.
    Melmed S, Casanueva FF, Hoffman AR, et al.; Endocrine Society. Diagnosis and treatment of hyperprolactinemia. J Clin Endocrinol Metab. 2011;96(2):273–88.Google Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • An-Guor Wang
    • 1
  1. 1.Department of OphthalmologyTaipei Veterans General Hospital, National Yang-Ming University School of Medicine, Yun-San Ophthalmology Education Research FoundationTaipeiTaiwan

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