Case Conference

Present: R3 周宗賢Modulator: Dr. 郭千能

Brief History ID No.: 92217874 Gender: Male Age: 62 CC: Blurred vision (OU) concomitant

with headache over bilateral frontal area for about one month

PH: NKA, Asthma: positive FH: No contributory

Ocular Exam OD OS VAcC: 0.1(0.1X+0.75/-1.5X45) 0.1(0.2X+1.75/-0.5X170) PT: 14mmHg 18mmHg Pupil 3mm 3mm L/R: + + RAPD: - - EOM: full and free full and free K: mild ksd mild ksd AC: D/C D/C Lens: PCIOL with PCO +2-+3 N2C1P1 Fundus: tessellated tessellated

Treatment course: YAG PC : 1.2 mj/19 spots (OD) After treatment: VACC OD:

0.1(0.2+2X+0.75/-1.5X45)

Differential diagnosis pituitary adenoma Meningioma craniopharyngioma traumatic injury glioma Aneurysm germinoma metastatic tumor Others: sarcoidosis, etc

Further evaluation

Lab data: 檢驗項目 檢驗值 單位 H/L 參考值 ===================================T4 8.2 ug/dL 4.8 - 12.5TSH 0.814 uIU/mL 0.35 - 5.50hGH 0.95 ng/mL 0.06 - 5.0PROLACTIN 23.08 ng/mL H F:1.39-24.2 M:1.61-18.77LH 2.73 mIU/mL 0.8 - 57.3FSH 9.07 mIU/mL 0.8 - 20.9CORTISOL 8.40 ug/dL AM7-9:4.3-22.4 PM3-5:3.1-16.7PROGESTERO 0.46 ng/mL 0.2 - 25.2TESTOSTERO 5.72 ng/mL F:0.14-0.76 M:2.41-8.27

CT: Enlarged pituitary fossa with bony scalloping and soft tissue opacification

Discussion

Pituitary adenomas Cell type Prevalence (%) Lactotroph cell adenoma 26 Null cell adenoma 17 Somatotroph adenoma 14 Corticotroph adenoma 15 Plurihormonal cell adenoma 13 Oncocytoma 6 Gonadotroph cell adenoma 8 Thyrotroph cell adenoma 1

Meyer’s loop carries information from the inferior retina

Causative factors of temporal lobe malfunction The most common cause: neoplasm (Glioma and metastasis) Abscess formation Vascular cause Demyelinating disease Congenital malformation

Conclusion Follow up of visual field Arrange MRI if indicated

Thanks for your attention