An elderly man with a hx of HTN, HLD who presented to clinic with decreased vision and hypogonadism – MRI demonstrated a 3 cm sellar mass compressing the optic chiasm. He underwent transsphenoidal resection, which was complicated by hypopituitarism necessitating hormone replacement with levothyroxine, hydrocortisone, and testosterone.
DDx for visual field cut -> pituitary adenoma, sellar mass, glaucoma
DDx for sellar mass -> pituitary adenoma, prolactinoma, brain metastases, meningioma/craniopharyngioma, granulomatous disease (sarcoid, TB)
Any sellar mass that causes visual field deficits
Macradenoma vs. Microadenoma – Microadenomas should not cause visual symptoms – and are defined as < 1 cm
A common/serious complication of transphenoidal resection is a CSF leak
TSH will NOT be accurate in pituitary adenoma – you have to test the free T4 as well to determine hyperthyroid state