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Pituitary macroadenoma - Null Cell (non-secreting)

Krause RJK - MedPix (2013)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Pituitary macroadenoma - Null Cell (non-secreting)

History: 21 y.o. woman reservist, activated & deployed into Iraq in March. Air evacuated to Germany and then subsequently to WRAMC in mid July for dyspnea. Pulmonology evaluation made a diagnosis of asthma, and she was started on PO steroid burst w/ taper, albuterol, Advair and Singulaire. R-sided visual loss (OD) started shortly after initiating these asthma meds and remained stable over next 1-2 weeks. She then reported “I can’t see person standing to my right”. She denied any sudden onset - but is unable to pinpoint the moment when her symptoms began nor recall what she was doing; no “falling curtain”. - no central vision loss OU - no vision changes OS - no floaters, photopsia or amaurosis - no headache, eye pain or photophobia - no gross neurologic symptoms (diplopia, dysarthria, weakness, parasthesias, confusion) - PMH/PSH: recent asthma dx - FH: non-contributory - Social Hx: no tobacco/rare EtOH 1 previous sexual partner 2 years ago - Meds: PO Prednisone taper (currently 20mg qd) Albuterol Singular Advair OCP -Allergies: PCN

Findings: Presumably new-onset, painless, diffuse R monocular field loss w/ +APD and subtle abnormalities of R optic disc Large intrasellar and suprasellar mass lesion

Ddx: -Optic nerve disease: neuropathy: compressive/infiltrative, inflammatory, ischemic, toxic optic nerve drusen - Retrobulbar optic neuritis - Neuroretinitis (Bartonella, Syphilis, Lyme) -Intracranial Process: - mass (pit adenoma, meningioma, glioma, craniopharygioma) - aneurysm (most likely ICA) inflammation (sarcoid, MS) - Retinal Dystrophy/Degeneration: - fundus flavimaculatus

Dxhow: Surgical resection and histology

Exam: - BCVA: 20/20 -2 OU (low myope OU) - color vision (PIP): 10/14 OD 11/14 OS - red desaturation: 90% OD - white light brightness: 75% OD - pupils: 4->3mm OU, 2+ APD OD - Motility: FD & V OU - Visual Fields: gross defect to confrontation 7-9 clock hours OD; full OS - IOP: 16 OU - SLE: normal anterior segment OU - DFE: Lens/vitreous: clear OU macula: +FLR, flat and unremarkable OU A/V: normal caliber w/o nicking, tortuosity, attenuation, or sheathing OU Periphery: flat and unremarkable OU Disc: 0.1 C/D OU w/o pallor/heme slightly increased fullness/elevation OD, but sharp disc margins/clearly-defined vessels single flat, hypopigmented lesion just inferior to disc margin OD (1/5 DD)

No MeSH data available.


Clinical Presentation by Endocrine Secretion
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Related In: Results  -  Collection

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MPX2591_synpic26004: Clinical Presentation by Endocrine Secretion


Pituitary macroadenoma - Null Cell (non-secreting)

Krause RJK - MedPix (2013)

Clinical Presentation by Endocrine Secretion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2591&req=5

MPX2591_synpic26004: Clinical Presentation by Endocrine Secretion

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Pituitary macroadenoma - Null Cell (non-secreting)

History: 21 y.o. woman reservist, activated & deployed into Iraq in March. Air evacuated to Germany and then subsequently to WRAMC in mid July for dyspnea. Pulmonology evaluation made a diagnosis of asthma, and she was started on PO steroid burst w/ taper, albuterol, Advair and Singulaire. R-sided visual loss (OD) started shortly after initiating these asthma meds and remained stable over next 1-2 weeks. She then reported “I can’t see person standing to my right”. She denied any sudden onset - but is unable to pinpoint the moment when her symptoms began nor recall what she was doing; no “falling curtain”. - no central vision loss OU - no vision changes OS - no floaters, photopsia or amaurosis - no headache, eye pain or photophobia - no gross neurologic symptoms (diplopia, dysarthria, weakness, parasthesias, confusion) - PMH/PSH: recent asthma dx - FH: non-contributory - Social Hx: no tobacco/rare EtOH 1 previous sexual partner 2 years ago - Meds: PO Prednisone taper (currently 20mg qd) Albuterol Singular Advair OCP -Allergies: PCN

Findings: Presumably new-onset, painless, diffuse R monocular field loss w/ +APD and subtle abnormalities of R optic disc Large intrasellar and suprasellar mass lesion

Ddx: -Optic nerve disease: neuropathy: compressive/infiltrative, inflammatory, ischemic, toxic optic nerve drusen - Retrobulbar optic neuritis - Neuroretinitis (Bartonella, Syphilis, Lyme) -Intracranial Process: - mass (pit adenoma, meningioma, glioma, craniopharygioma) - aneurysm (most likely ICA) inflammation (sarcoid, MS) - Retinal Dystrophy/Degeneration: - fundus flavimaculatus

Dxhow: Surgical resection and histology

Exam: - BCVA: 20/20 -2 OU (low myope OU) - color vision (PIP): 10/14 OD 11/14 OS - red desaturation: 90% OD - white light brightness: 75% OD - pupils: 4->3mm OU, 2+ APD OD - Motility: FD & V OU - Visual Fields: gross defect to confrontation 7-9 clock hours OD; full OS - IOP: 16 OU - SLE: normal anterior segment OU - DFE: Lens/vitreous: clear OU macula: +FLR, flat and unremarkable OU A/V: normal caliber w/o nicking, tortuosity, attenuation, or sheathing OU Periphery: flat and unremarkable OU Disc: 0.1 C/D OU w/o pallor/heme slightly increased fullness/elevation OD, but sharp disc margins/clearly-defined vessels single flat, hypopigmented lesion just inferior to disc margin OD (1/5 DD)

No MeSH data available.