The most common ophthalmological sign of a pituitary adenoma is the bitemporal loss of visual field (see Chaps. 3 and 4). Fundus findings are at most (and often subtly) optic disc pallor. A loss of visual acuity is not always present (see above). Disturbances of motility involving dysfunction of the trochlear or abducens nerves are found in only about 10% of patients. With very large, eccentrically growing tumors, there is occasionally damage to the first two branches of the trigeminal nerve.
ment. A primary deficit of a pituitary end organ's hormonal production (e.g., primary hypothyroidism) could cause a secondary swelling of the pituitary gland of sufficient size to make contact with the chiasm. In such cases, simple replacement of the missing hormone will lead to a reversal of the syndrome.
No surgery should be considered for a pituitary tumor prior to a complete endocrinological evaluation.
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