Posters

That tiny detail that has changed it all: it is not just a stroke of good fortune

Poster Details

First Author: H.Hnich MOROCCO

Co Author(s):    A. Boujaada   K. Mrad   A. Aboulanouar   A. Berraho Hamani   .         

Abstract Details

Purpose:

To report an interesting case of pituitary apoplexy revealed by unilateral posterior optic neuropathy simulating giant cell artetritis disease. Through our observation, we aim to increase consciousness among ophthalmologists to perform a meticulous ophthalmological examination and at the slightest clinical doubt requesting further examinations in order to establish the right diagnosis at the right time.

Setting:

Pituitary apoplexy is a clinical diagnosis requiring both acute onset of vision loss, hypopituitarism, and/or severe headaches, as well as a hemorrhagic or infarcted pituitary lesion. It affects 0.2% to 0.6% of the general population and can vary, affecting between 2% and 12% of patients with pituitary adenomas.

Methods:

A 61 years old female patient with history of poorly controlled arterial hypertension presented with subacute severe headaches, neck pain, unilateral severe vision loss of the left eye and diplopia. Ophthalmologic examination found visual acuity reduced to motion of fingers, the swinging-flashlight test showed a mild relative afferent pupillary defect, a mild deficiency of the adduction of the left eye, a little retraction of the the lower eyelid was noted in comparision with the contralateral eye, which made us think of a possibility of mild proptosis. The fundoscopy was normal. Both of the right eye and neurological examination was unremarkable.

Results:

The presence of such symptoms in an old patient has raised our alarm bells and thus erythrocyte sedimentation rate and C-reactive protein were performed both returned negative. The possibility of the proptosis and the negativity of inflammatory markers made us complete by orbito cerebral CT that has surprisingly showed pituitary hemorrhage. MRI proved the diagnosis and the hypopituitarism features were confirmed by the presence of hormone deficiency. The patient has undergone a surgical endonasal excision and the histopathological analysis endorses the diagnosis of pituitary adenoma. A total ocular recovery was noted; the visual acuity was increased to 9/10.

Conclusions:

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies. The ocular manifestations are very described during this serious affection but when they are unilateral they may mislead us into wrong diagnosis.

Financial Disclosure:

None