Pituitary apoplexy without chiasm compression: A case report

Kynčl,Martin; Kasl,Zdeněk; Rusňák,Štěpán; Sobotová,Marketa; Krčma,Michal; Tintěra,Jaroslav; Fůs,Martin; Lešták,Jan

doi:10.3892/mco.2021.2338

Pituitary apoplexy without chiasm compression: A case report

Authors:
- Martin Kynčl
- Zdeněk Kasl
- Štěpán Rusňák
- Marketa Sobotová
- Michal Krčma
- Jaroslav Tintěra
- Martin Fůs
- Jan Lešták
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Affiliations: Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic, Department of Ophthalmology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic, First Clinic of Internal Medicine, Department of Endocrinology, University Hospital in Pilsen, 301 00 Pilsen, Czech Republic
Published online on: June 30, 2021 https://doi.org/10.3892/mco.2021.2338
Article Number: 176
Copyright: © Kynčl et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present report presents a rare case in which a patient with pituitary apoplexy (PA) without compression of the optic chiasm experienced diagnosable visual impairment in the ensuing months. Endocrinologically, the condition was a prolactinoma followed by bleeding into the pituitary gland. Due to the unexplained functional changes in the patient, an electrophysiological examination (pattern electroretinogram and pattern visual evoked potentials) was performed, which verified a bilateral non‑inflammatory neurogenic lesion. This finding was confirmed by functional magnetic resonance imaging (fMRI) examination. Structural MRI did not reveal chiasm compression in the time sequence or alteration of the optic nerves (the diameter of the optic nerve at different distances from the eye and the diameter of the optic nerve sheath at different distances from the eye). Similarly, neither the retinal nerve fiber layer (RNFL) nor the vessel density was altered. The present report suggests that changes in visual fields may be due to ischemia in the area of the chiasm and optic nerves, similar to PA.

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