Ramkali bai, a 35 year old female presented with one year history of menstrual irregularity and galactorrhea. She also had off-and-on headache. Her examination revealed bitemporal superior quadrantopia. Her fundus examination showed primary optic atropy. Which of the following is the most likely diagnosis in this case :
Answer is B (Pituitary macroadenoma): Presence of long standing endocrinopathies (menstrual irregularities and galactorrhea) in an adult suggests a diagnosis of pituitary adenoma over craniopharyngiomas as the latter are primarily tumours of childhood. Visual field defects and optic atrophy suggest local mass effects which are associated with 'macroadenomas' and hence the most likely diagnosis is a pituitary macroadenoma. Note 'Pituitary adenomas are the most common cause of pituitary hormonal syndromes in adults - Harrison 'The functional tumors often produce clinical symptoms of endocrinopathies when they are still small (microadenomas) and restricted to sella. When a tumor grows outside the sella (macroadenoma) it compresses the optic chiasma and nerves and produces a variety of visual defects, the most common being a complete or incomplete bitemporal hemianopia'- API As the tumor progresses it may result in optic atrophy and blindness. Optic gliomas occur mainly in childhood and presentation is usually with visual loss and not endocrinal manifestations. Opthalmic ICA aneurysm is unlikely to present with long standing endocrinopathies over a year prior to appearance of visual symptoms. Craniopharyngiomas can be excluded as in the previous question.
Craniopharyngioma
Pituitary macroadenoma
Ophthalmic ICA aneurysm
Chiasmal glioma