A pediatric case of pituitary macroadenoma presenting with pituitary apoplexy and cranial nerve involvement: case report

Abstract

Pituitary adenomas usually arise from the anterior lobe of the pituitary gland and are manifested with hormonal disorders or mass effect. Mass effect usually occurs in nonfunctional tumors. Pituitary adenomas may be manifested with visual field defects or rarely in the form of total oculomotor palsy. Visual field defect is most frequently in the form of bitemporal hemianopsia and superior temporal defect. Sudden loss of vision, papilledema and ophthalmoplegia may be observed. Pituitary apoplexy is defined as an acute clinical syndrome characterized with headache, vomiting, loss of vision, ophthalmoplegia and clouding of consciousness. The problem leading to pituitary apoplexy may be decreased blood supply in the adenoma and hemorrhage following this decrease or hemorrhage alone. In this article, we present a patient who presented with fever, vomiting and sudden loss of vision and limited outward gaze in the left eye following trauma and who was found to have pituitary macroadenoma causing compression of the optic chiasma and optic nerve on the left side on cranial and pituitary magnetic resonance imaging.

Keywords: Adenoma; pituitary apoplexy; sudden loss of vision.

Figure 1. a–c.

(a) Limited outward gaze related with involvement of the sixth cranial nerve in the left eye before surgery (b, c) Improvement in involvement of the sixth cranial nerve in the follow-up; the eye movements are free in all directions

Figure 2.

Mass lesion with a size of approximately 3×3,5×3 cm which filled the base of the sella, compressed the left optic nerve and the optic chiasma on the left with regular borders and contrast enhancement following intravenous injection of contrast material