Pituitary Macroadenoma with Optic Cupping Masquerading as Normal Tension Glaucoma

Area of Science:

• Ophthalmology
• Neurology
• Endocrinology

Background:

• Differentiating normal-tension glaucoma (NTG) from other optic neuropathies with disc cupping is clinically challenging.
• Subjective assessment of optic disc features and overlapping signs with compressive intracranial lesions complicate NTG diagnosis.
• Ancillary tests like retinal nerve fiber layer (RNFL) analysis and visual field testing are crucial for identifying non-glaucomatous processes.

Observation:

• A case is presented involving a nonfunctional pituitary macroadenoma coexisting with NTG.
• The relationship between the intracranial lesion and the development or exacerbation of NTG remains uncertain.
• The patient presented with optic disc cupping and visual field abnormalities suggestive of an intracranial lesion, despite a lack of other neurological symptoms.

Findings:

• The coexisting macroadenoma presented diagnostic challenges, mimicking typical glaucomatous optic nerve damage.
• Visual field deficits were observed, but their pattern did not perfectly align with either NTG or the macroadenoma alone.
• The case underscores the difficulty in attributing optic disc and visual field changes solely to glaucoma when an intracranial lesion is present.

Implications:

• This case highlights the importance of considering intracranial pathology in the differential diagnosis of suspected NTG, especially when ancillary tests show incongruous results.
• Recognizing optic cupping and non-matching visual field abnormalities is critical for accurate diagnosis and management.
• Further investigation into the interplay between pituitary macroadenomas and glaucoma is warranted to improve diagnostic strategies.