Unexplained Vision Loss and Hormonal Abnormalities in Young Male - A Case Report
A case report presented at the 9th Annual State Ophthalmological Conference TOSCON 2024 discusses a young male patient grappling with unexplained vision loss and hormonal abnormalities. The patient exhibited symptoms of headache, diminished vision in the left eye, and an unusual head-turning behavior. Orthoptic evaluations revealed sensory disparities between the eyes, prompting further investigation. Hormonal evaluation showed notable abnormalities, leading to the diagnosis of pituitary hyperplasia. Treatment involves thyroid hormone replacement and careful monitoring to address the visual impairment and hormonal imbalances.
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GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9thAnnual State Ophthalmological Conference TOSCON 2024 12thto 14thJuly, 2024 at Katriya Hotel & Towers, Hyderabad E-POSTER NO: EP212 GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. A CASE REPORT AUTHOR : DR. M.SPOORTHI JUNIOR RESIDENT SDEH HYDERABAD CO AUTHOR: DR. Y. RAMAN PROFESSOR HEAD OF SQUINT DEPARTMENT SDEH HYDERABAD
GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad INTRODUCTION Pituitary hyperplasia is an under recognised manifestation which can occur fairly in primary hypothyroidism. they can present with hypothyroidism, hyperprolactinemia and even visual field defects. This recognition is important as the primary modality of treatment is mainly thyroid hormone replacement and not surgery.
GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad MATERIALS AND METHODS A 26 years old male patient presented with complaints of headache, diminition of vision in lefteye and turning of head when patient wants to look laterally in right eyes since childhood. Orthoptic Evaluation: Head Posture: none;Facial Symmetry: Maintained; Ocular Symmetry: maintained Hirschberg Corneal Reflex Test: [BE] CENTRAL colourvision : Right eye 25/25 Left eye 12/25 Brightness and contast sensitivity :decreased in left eye when compared with right eye FUNDUS- LEFT EYE:NORMAL RIGHT EYE:NORMAL OPTIC PATHWAY DTI:NORMAL
GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad INVESTIGATION Hormonal evaluation :FT4 - 0.3 mg/dl [normal-0.89-1.76],TSH - 150 mg/dl[0.55-4.78] ,FT3 - 1.45 PG/UL [N-2.3-4.2], ACTH - 49 mg/dl [<46], prolactin - 41 mg/dl [4.04-15.2]. antitpo - >600 IU/ml, usg neck - B/L thyroid lobes - mildly bulky, altered echotexture ,increased vasculature MRI BRAIN WITH ORBITS CONTRAST: DENSE OF 1.6*1.5*1.2 CM WELL DEFINED T1-T2 FLAIR isointense lesion noted in sella causing widening of sella.Infundibular stalk is midly deviated towards right. post- contrast: homogenous enhancement [BE] HVF-PERIPHERAL VISUAL FIELD DEFECTS LE>RE VEP - RIGHT SIDE normal. LEFT SIDE - abnormal VEP study. DENSE OF 1.6*1.5*1.2 CM WELL DEFINED T1- T2 FLAIR isointense lesion noted in sella
GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad DISCUSSION Repeat HVF after 3 months showed visual field improvemen t in right eye Our patient was diagnosed as primary hypothyroid [autoimmune antiTPO +ve] with thyrotrophic hyperplasia and visual field defects in both eyes. He was managed with T.ectroxin 150mcg OD daily and reviewed after 3 months on which he showed improvement of visual field defect in right eye, Tsh improved to 7.7 mg/dl. Repeat MRI pituitary showed shrinkage of pituitary mass from 1.6*1.5*1.2 cm homogenous enhancement to 1.3*1.2*9 mm normal size and enhancement Patient kept on follow up. RIGHT EYE LEFT EYE
GRAPPLING WITH DARKNESS: UNEXPLAINED VISION LOSS AND HORMONAL ABNORMALITIES IN A YOUNG MALE. DR MUSHAM SPOORTHI 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad CONCLUSION The characteristic visual field defect in pituitary adenoma/hyperplasia is bitemporal hemianopia. Rarely one pattern which can also occur is reduced peripheral vision of both sides in one or both eyes Pituitary hyperplasia can occur in primary hypothyroidism due to negative feedback on hypothalamus and pituitary. The presentation and imaging can mimic pituitary mass. This case highlights the importance of considering early presentation, hormonal evaluation and prompt hormonal therapy for effective results.
