10-Question Multiple Choice Quiz: Pituitary Tumors, A Clinical Guide for Eye Doctors

1. What is the classic visual field defect associated with compression of the optic chiasm by a pituitary tumors (macroadenoma)?

A. Central scotoma

B. Bitemporal hemianopia

C. Homonymous hemianopia

D. Inferior arcuate defect

2. Why can pituitary tumors cause visual field defects?

A. They directly damage the retina

B. They increase intraocular pressure

C. Superior tumor extension can compress the optic chiasm

D. They usually cause retinal vascular occlusion

3. Which visual field pattern should raise suspicion for a neurologic or chiasmal lesion?

A. A defect respecting the horizontal raphe

B. A defect respecting the vertical midline

C. An isolated paracentral scotoma

D. A nasal step consistent with glaucoma

4. Which automated visual field tests may be useful when evaluating suspected chiasmal compression?

A. Humphrey 10-2 only

B. Humphrey 24-2 or 30-2

C. FDT screening only

D. Amsler grid testing only

5. Which OCT finding may support the diagnosis of compressive optic neuropathy from a pituitary tumor?

A. Increased central corneal thickness

B. Nasal macular ganglion cell loss and RNFL thinning

C. Epiretinal membrane formation

D. Increased choroidal thickness

6. A normal-appearing optic nerve and fundus examination means that chiasmal compression can be ruled out.

A. True

B. False

C. Only in patients under age 40

D. Only if visual acuity is 20/20

7. Which combination of findings should increase concern for cavernous sinus involvement from a large pituitary lesion?

A. Floaters and photopsias

B. Diplopia, ptosis, and cranial nerve palsy

C. Dry eye and fluctuating vision

D. Macular drusen and metamorphopsia

8. What is typically the preferred imaging study when a compressive pituitary lesion is suspected?

A. Orbital ultrasound

B. CT of the sinuses without contrast

C. MRI of the brain and orbits with attention to the sella/pituitary

D. Carotid ultrasound

9. Which presentation should raise immediate concern for pituitary apoplexy?

A. Slowly progressive myopia

B. Mild intermittent dry eye

C. Sudden severe headache with acute vision loss and ophthalmoplegia

D. Gradual development of presbyopia

10. What is an important role of the eye doctor after treatment of a pituitary tumor?

A. Monitor only intraocular pressure

B. Perform serial visual fields, OCT, visual acuity, pupil, and optic nerve assessments

C. Discontinue follow-up once surgery is completed

D. Monitor refractive error only

Answer Key

1. B. Bitemporal hemianopia

2. C. Superior tumor extension can compress the optic chiasm

3. B. A defect respecting the vertical midline

4. B. Humphrey 24-2 or 30-2

5. B. Nasal macular ganglion cell loss and RNFL thinning

6. B. False

7. B. Diplopia, ptosis, and cranial nerve palsy

8. C. MRI of the brain and orbits with attention to the sella/pituitary

9. C. Sudden severe headache with acute vision loss and ophthalmoplegia

10. B. Perform serial visual fields, OCT, visual acuity, pupil, and optic nerve assessments