Pituitary macroadenoma misdiagnosed as advanced normal tension glaucoma

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Abstract

Purpose

To present the clinical case of a patient with a giant pituitary adenoma that was misdiagnosed for several years and treated as a progressive NTG (Normal Tension Glaucoma).

Methods

A 57 years old male had his first ocular examination in December 2008 and was diagnosed with NTG and started on topical treatment. The patient was declared unable to perform automated perimetry, so he was referred for Goldmann perimetry. He had several ocular exams over a period of four years, during which the treatment was gradually increased to maximal topical therapy, but the patient still developed a progressive impairment of the visual acuity, visual field and fundus aspect.

Results

The patient was referred to our clinic in August 2012 for surgical management of his bilateral severe progressive glaucoma. During the hospital admittance, we performed automated perimetry that showed hemianopsia; he was referred afterwards for cerebral MRI and diagnosed with giant extensive pituitary adenoma. The patient had surgery, but he continued to lose visual acuity and optic atrophy installed at both eyes.

Conclusion

NTG should remain an exclusion diagnosis (after excluding a chiasm compression as well).

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