Pituitary hyperplasia causing complete bitemporal hemianopia with resolution following surgical decompression: case report

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  • 1 Departments of Neurosurgery,
  • 2 Endocrinology, and
  • 4 Pathology, Albany Medical College; and
  • 3 Department of Surgery, Division of ENT, Albany Medical College, Albany, New York
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In this report, the authors demonstrated that idiopathic pituitary hyperplasia (PH) can cause complete bitemporal hemianopia and amenorrhea, even in the setting of mild anatomical compression of the optic chiasm and normal pituitary function. Furthermore, complete resolution of symptoms can be achieved with surgical decompression.

PH can occur in the setting of pregnancy or end-organ insufficiency, as well as with medications such as oral contraceptives and antipsychotics, or it can be idiopathic. It is often found incidentally, and surgical intervention is usually unnecessary, as the disorder rarely progresses and can be managed by treating the underlying etiology. Here, the authors present the case of a 24-year-old woman with no significant prior medical history, who presented with bitemporal hemianopia and amenorrhea. Imaging revealed an enlarged pituitary gland that was contacting, but not compressing, the optic chiasm, and pituitary hormone tests were all within normal limits. The patient underwent surgical decompression of the sella turcica and exploration of the gland through an endoscopic endonasal transsphenoidal approach. Pathology results demonstrated PH. A postoperative visual field examination revealed complete resolution of the bitemporal hemianopia, and menstruation resumed 3 days later. The patient remains asymptomatic with no hormonal deficits.

ABBREVIATIONS PH = pituitary hyperplasia.

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Contributor Notes

Correspondence Maria Peris-Celda: Albany Medical College, Albany, NY. periscm@amc.edu.

INCLUDE WHEN CITING Published online August 14, 2020; DOI: 10.3171/2020.5.JNS20448.

Disclosures Dr. Kenning reports being a consultant for Stryker CMF and Collagen Matrix.

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