Rapid visual field constriction in a patient with retinitis pigmentosa and pituitary adenoma

• Main Authors: Hayder Al-Hasani, Naheed W. Khan, Kari H. Branham, John R. Heckenlively, Stephen E. Sullivan, Lindsey B. De Lott, Abigail T. Fahim
• Format: Article
• Language: English
• Published: Elsevier 2020-09-01
• Series: American Journal of Ophthalmology Case Reports
• Subjects: Retinitis pigmentosa; Pituitary adenoma; Chiasmal pathology; Rapid visual field constriction; Rapid visual acuity reduction; Neuro-imaging
• Online Access: http://www.sciencedirect.com/science/article/pii/S2451993620301134

Purpose: To report a case of pituitary adenoma in a patient with retinitis pigmentosa (RP) and consequent rapid constriction of the visual field in each eye, which is atypical for either of these pathologies. Observations: A 45-year old male, with a long-standing history of RP, presented with rapid vision loss over 3 months. Examination revealed a severe drop in visual acuity and significant progression of concentric visual field constriction in each eye compared to 3 months prior. MRI revealed a pituitary macroadenoma compressing the optic chiasm. The patient underwent endoscopic trans-sphenoidal resection of the tumor and experienced partial recovery of visual acuity but not visual field. Conclusions and importance: The visual field deficit in this patient was atypical for pituitary adenoma or optic neuropathy. The pattern was most consistent with RP, but the rate of progression was not. In a patient with chiasmal pathology in the setting of pre-existing retinopathy, visual field progression may not be limited exclusively to the bitemporal regions. Rapid constriction of the visual field in a patient with RP should prompt a work-up for alternative etiologies which includes neuro-imaging.