Pituitary Adenoma Presenting with True Bitemporal Hemianopsia: A Case Report

Afrim Shabani, Flamur Mushica, Besim Latifaj, Jeton Shatri, Ardita Kafexholli, Dijon Musliu, Art Deva, Redon Jashari, Premtim Rashiti

International Journal of Biomedicine. 2023;13(2):353-356.
DOI: 10.21103/Article13(2)_CR4
Originally published June 5, 2023


Pituitary adenomas grow from the anterior pituitary gland and can cause compression of surrounding structures, including the optic chiasm, leading to visual field defects such as bitemporal hemianopia, visual acuity or color perception reduction. In this case report, we present the case of a 45-year-old male patient who presented with long-lasting headaches and visual disturbances, including diplopia and a decline in visual acuity. Despite being initially diagnosed with migraine by a neurologist, a thorough ophthalmological examination revealed visual field defects consistent with true bitemporal hemianopsia. MRI results confirmed the presence of sellar mass, and the patient was referred to the neurosurgery department for immediate intervention. The patient underwent surgical removal of the mass, which was identified as a pituitary adenoma upon histological examination. Three months later, the patient experienced significant improvements in subjective and objective visual acuity, with no diplopia or scotomas in the visual field. In conclusion, this case report highlights the importance of considering pituitary adenoma as a potential cause of visual disturbances, even in the absence of bitemporal hemianopsia. Thorough ophthalmological examination, including visual field testing, can aid in the early detection of chiasmal involvement and prompt referral for further investigation. Early intervention, including surgical removal of the tumor, can prevent other complications and significantly improve visual acuity and overall quality of life for patients.

pituitary adenoma • sellar mass • bitemporal hemianopsia
  1. Snyder R, Fayed I, Dowlati E, Seager A, Mason RB. Pituitary Adenoma and Craniopharyngioma Collision Tumor: Diagnostic, Treatment Considerations, and Review of the Literature. World Neurosurg. 2019 Jan;121:211-216. doi: 10.1016/j.wneu.2018.10.048.
  2. Lee DK, Sung MS, Park SW. Factors Influencing Visual Field Recovery after Transsphenoidal Resection of a Pituitary Adenoma. Korean J Ophthalmol. 2018 Dec;32(6):488-496. doi: 10.3341/kjo.2017.0094. 
  3. Fredes F, Undurraga G, Rojas P, Constanzo F, Lazcano C, Pinto J, Schmidt T. Visual Outcomes after Endoscopic Pituitary Surgery in Patients Presenting with Preoperative Visual Deficits. J Neurol Surg B Skull Base. 2017 Dec;78(6):461-465. doi: 10.1055/s-0037-1604169. 
  4. Foroozan R. Visual Findings in Chiasmal Syndromes. Int Ophthalmol Clin. 2016 Winter;56(1):1-27. doi: 10.1097/IIO.0000000000000097. 
  5. Rowe FJ, Cheyne CP, García-Fiñana M, Noonan CP, Howard C, Smith J, Adeoye J. Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static. Neuroophthalmology. 2015 May 13;39(3):116-124. doi: 10.3109/01658107.2014.990985.
  6. Putri EFP, Kartika A, Sari RH, Veulina D, Yollamanda P. Visual Field Improvement After Pituitary Tumor Resection. xxxxxx2022;4(1).
  7. Lee IH, Miller NR, Zan E, Tavares F, Blitz AM, Sung H, Yousem DM, Boland MV. Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia. AJR Am J Roentgenol. 2015 Nov;205(5):W512-8. doi: 10.2214/AJR.15.14527. 
  8. Deleu L. Kyste de la poche de Rathke compressif révélé par une hémianopsie bitemporale [Compressive Rathke's pouch cyst discovered due to bitemporal hemianopsia]. J Fr Ophtalmol. 2021 Jun;44(6):915-917. [Article in French]. doi: 10.1016/j.jfo.2020.10.017. 
  9. Stein TD, Chae YS, Won N, Lee JH, Hedley-Whyte ET. A 34-year-old man with bitemporal hemianopsia. Brain Pathol. 2014 Jan;24(1):107-10. doi: 10.1111/bpa.12108. 
  10. Azarpira N, Pakbaz S, Torabineghad S, Musavi J, Rakei M. Acromegaly associated with mixed pituitary adenoma-gangliocytoma and Rathke's cleft cyst. Turk Neurosurg. 2013;23(4):527-30. doi: 10.5137/1019-5149.JTN.5241-11.1. 
  11. Gupta A, Deshmukh M, Palexas G. Pituitary Macroadenoma Presenting With Monocular Temporal Hemianopia. J Neuroophthalmol. 2021 Jun 1;41(2):e267-e268. doi: 10.1097/WNO.0000000000001119. 
  12. Dhepnorrarat RC, Ang BT, Sethi DS. Endoscopic surgery of pituitary tumors. Otolaryngol Clin North Am. 2011 Aug;44(4):923-35, viii. doi: 10.1016/j.otc.2011.06.019. 
  13. Uy B, Wilson B, Kim WJ, Prashant G, Bergsneider M. Visual Outcomes After Pituitary Surgery. Neurosurg Clin N Am. 2019 Oct;30(4):483-489. doi: 10.1016/j.nec.2019.06.002. 
  14. Sun M, Zhang ZQ, Ma CY, Chen SH, Chen XJ. Predictive factors of visual function recovery after pituitary adenoma resection: a literature review and Meta-analysis. Int J Ophthalmol. 2017 Nov 18;10(11):1742-1750. doi: 10.18240/ijo.2017.11.17. 

Download Article
Received April 15, 2023.
Accepted May 17, 2023.
©2023 International Medical Research and Development Corporation.