Bitemporal Hemianopia due to Hypophyseal Adenomas

R M Irsan*, Devi Azri Wahyuni

Ophthalmology Department faculty of Medicine Sriwijaya University / Mohammad Hoesin Hospital
Palembang, South Sumatera, Indonesia
Introduction: Lesions at the posterior chiasm may compress only the crossing fibers derived from
the macular region, producing a central bitemporal hemianopia. Pituitary or hypophyseal adenomas
are the most common cause of chiasmal compression and may occur at any adult age
Objective: To report a cases of bitemporal hemianopia due to hypophyseal adenoma
Method: Four patients with history of intermittent headache and blur vision. Pertinent ophthalmology
examination, hormonal and imaging evaluation were performed.
Result : Three patient had severe monocular VA deterioration and 1 patient had mild binocular blur
vision. Clinical presentation showed acromegaly and macroglosy in 1 patient and amenorea in 1
patient. From ophthalmology evaluation, 3 patients had positive RAPD, optic nerve atrophy found in
1 patient, dyschromatopsias and decrease of contrastsensitivity occured in all patients. Visual field
(VF) evaluation showed 2 patient with bitemporal hemianopia and 2 patient monocular temporal field
defect with VF of fellow eye could not performed. Hormonal status showed increased of GH (>40
ng/ml) and prolactin (21.42 ng/ml) in 1 patient, TSH (5.57 IU/ml) and prolactin (43 IU/ml) in 1
patient, GH (>200 ng/ml) in 1 patient . Contrast enhanced MRI evaluation showed hypophyseal
adenomas in all patients. Two cases managed with hormonal therapy and two cases referred to
neurosurgeon.
Conclusion: Patient with hypophyseal adenoma may initially only complain for mild blurred vision
and headache. Thorough anamnesis, examination and ancillary examination should perform to
establishing diagnosis. Decision whether surgical or hormonal management may indicated based on
clinical consideration