Pituitary Macroadenoma With Hemorrhage

After being hit on the head during a football game, a 16-year-old experienced several seconds of complete vision loss in the left eye. A few days later, he noticed the onset of blurred vision in the same eye, which progressively worsened over several weeks.

Six weeks after the initial head injury, the teenager suffered a spontaneous, excruciating, steady, total headache from 7 pm to 5 am the next morning. Ophthalmologic and neurologic evaluations revealed a pituitary macroadenoma with hemorrhage as seen in the precontrast, coronal MRIs (A and B) and the sagittal MRI with contrast (C). (Figure C was taken with the patient lying supine; the darker area is settled red blood cells.) The anteroposterior, coronal magnetic resonance angiograph demonstrates the internal carotid arteries on each side of the tumor (D). (Note that the anterior cerebral arteries are pushed up by the tumor; ordinarily these would be flat.)

Approximately 2 weeks after the severe headache, which probably marked the hemorrhage of the pituitary tumor, the patient underwent transsphenoidal pituitary tumor resection via a sublabial approach. His recovery from surgery was uneventful, except for a 2-week postoperative loss of the senses of taste and smell.

Drs Robert P. Blereau, James Kountoupis, and Tim Haley of Morgan City, La, report that this patient now has no headache but does have left peripheral field vision loss that he is unaware of when using binocular vision. The teenager's serum prolactin levels have been normal with bromocriptine therapy; it is anticipated that he will need to take this drug for the rest of his life.