1. The patient is a 62-year-old male who presented with blurred vision and headaches for one month. Examination found mild cataracts and tessellated fundi in both eyes. 2. Imaging found an enlarged pituitary fossa with bony changes and soft tissue, suggestive of a pituitary tumor. 3. Laboratory tests found slightly elevated prolactin and slightly decreased TSH, consistent with a possible prolactinoma or non-functioning pituitary adenoma. 4. The differential diagnosis includes pituitary adenoma, meningioma, craniopharyngioma, or other etiologies. Follow-up with visual field testing and MRI is planned.

1. Case Conference Present: R3 周宗賢 Modulator: Dr. 郭千能

2. Brief History ID No.: 92217874 Gender: Male Age: 62 CC: Blurred vision (OU) concomitant with headache over bilateral frontal area for about one month PH: NKA, Asthma: positive FH: No contributory

3. Ocular Exam OD OS VAcC: 0.1( 0.1X+0.75/-1.5X45) 0.1(0.2X+1.75/-0.5X170) PT: 14mmHg 18mmHg Pupil 3mm 3mm L/R: + + RAPD: - - EOM: full and free full and free K: mild ksd mild ksd AC: D/C D/C Lens: PCIOL with PCO +2-+3 N2C1P1 Fundus: tessellated tessellated

4. Treatment course: YAG PC : 1.2 mj/19 spots (OD) After treatment: VACC OD: 0.1(0.2+2X+0.75/-1.5X45)

7. Differential diagnosis pituitary adenoma Meningioma craniopharyngioma traumatic injury glioma Aneurysm germinoma metastatic tumor Others: sarcoidosis, etc

8. Further evaluation

9. Lab data: 檢驗項目 檢驗值 單位 H/L 參考值 ===================================T4 8.2 ug/dL 4.8 - 12.5 TSH 0.814 uIU/mL 0.35 - 5.50 hGH 0.95 ng/mL 0.06 - 5.0 PROLACTIN 23.08 ng/mL H F:1.39-24.2 M:1.61-18.77 LH 2.73 mIU/mL 0.8 - 57.3 FSH 9.07 mIU/mL 0.8 - 20.9 CORTISOL 8.40 ug/dL AM7-9:4.3-22.4 PM3-5:3.1-16.7 PROGESTERO 0.46 ng/mL 0.2 - 25.2 TESTOSTERO 5.72 ng/mL F:0.14-0.76 M:2.41-8.27

10. CT: Enlarged pituitary fossa with bony scalloping and soft tissue opacification

20. Discussion

22. Pituitary adenomas Cell type Prevalence (%) Lactotroph cell adenoma 26 Null cell adenoma 17 Somatotroph adenoma 14 Corticotroph adenoma 15 Plurihormonal cell adenoma 13 Oncocytoma 6 Gonadotroph cell adenoma 8 Thyrotroph cell adenoma 1

28. Meyer’s loop carries information from the inferior retina

29. Causative factors of temporal lobe malfunction The most common cause: neoplasm (Glioma and metastasis) Abscess formation Vascular cause Demyelinating disease Congenital malformation

30. Conclusion Follow up of visual field Arrange MRI if indicated

31. Thanks for your attention