Remarkable ophthalmic improvement following early diagnosis and treatment of paediatric prolactinoma-compressing optic chiasm: a case report

Abstract

Background: Prolactinomas frequently manifest as visual field defects and are often undetected due to their slow gradual progression. Chronic optic nerve compression will result in irreversible diffuse nerve atrophy and is associated with permanent severe vision and field loss.
Case report: A 12-year-old boy presented with acute visual loss, right eye ptosis, and decreased visual acuity (VA). Band atrophy at the optic disc and bitemporal hemianopia were found. MRI revealed a homogenic solid lesion in the intrasellar to suprasellar region, suggesting pituitary macroadenoma. Laboratory results showed increased prolactin hormone (33.6 ng/ml), decreased thyroid hormones (FT4 0.68 mg/dL and TSH 0.07 mg/dL), and decreased testosterone (< 0.025 ng/mL). Subfrontal craniotomy, hormonal therapy, and photon radiotherapy were done. On follow-up, VA was 6/6 and band atrophy and bitemporal hemianopia had disappeared.
Conclusion: Early diagnosis and treatment of prolactinomas might give a good clinical outcome for the patient.