Pituitary Adenoma Hidden by Comorbid Cataract

Abstract

Background: Background: A pituitary adenoma is an abnormal growth in the pituitary gland. Pituitary adenomas are the most common cause of sellar masses accounting for approximately 10% of all intracranial neoplasms. Early visual symptom of pituitary adenoma can be hidden by comorbid cataract in elderly patients. Case Case Report: Report: A 74 y.o. male presented to the eye clinic with blurry vision at all distances and has trouble with glare from lights. His best corrected visual acuity (BCVA) was 20/20-1 OD, 20/25-2 OS, but subjectively of poor quality. Slit lamp exam confirmed mild nuclear sclerotic cataract OU and normal fundus exam. Patient underwent uncomplicated cataract extraction with intraocular implant, OS first then OD. Post-op course was unremarkable until one month later when patient stated that his vision OS was blurry to the left. BCVA was 20/25 OD, 20/25-2 OS. Post-op exam was still normal including FCF. Humphrey visual field (HVF) however showed a bitemporal hemianopia. Patient was referred for a brain imaging. Brain MRI confirmed a 24 x 22 x 28 mm T2 isointense enhancing mass of the sella with suprasellar extension consistent with a pituitary macroadenoma. Patient underwent endonasal transphenoidal craniectomy for debulking of the tumor subsequently by an ENT specialist. Conclusion Conclusion: Clinicians need to be sure the cataract matches the visual complaint. When in doubt further ancillary testing such as comprehensive HVF is crucial to detect visual pathway disorder and brain tumors. Co-management with corresponding specialist is essential to preserve vision and save life.