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+A 29-year-old man consulted for several weeks for peripheral vision disturbances associated with manifestations of pituitary hypofunction.
+On examination he had a visual acuity (VA) of 1 in both eyes (AO), with normal anterior pole, intraocular pressure and fundus (FO). The visual field (VF) (Octopus 1-2-3 programme G1X) showed a superior arcuate defect with some peripheral changes in the right eye (RA) and a superior altitudinal defect and peripheral defects in the left eye (LO).
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+Urinalysis revealed hypodensity of practically water and hormone function studies showed undetectable FSH and LH, testosterone and growth hormone at below normal levels.
+Magnetic resonance imaging (MRI) showed dilatation of the left lateral ventricle, periventricular involvement of the third ventricle, the hypothalamus, as well as the region of the chiasm and contrast-enhancing optic nerves, compatible with granulomas in the aforementioned locations.
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+In the thoraco-abdomino-pelvic computed axial tomography (CT) with contrast, numerous lymph nodes were observed at the cervical, bilateral supraclavicular, bilateral axillary and also at the thoracic and pelvic levels. A deep axillary adenopathy was biopsied and was found to be compatible with sarcoidosis.
+The patient was diagnosed with systemic sarcoidosis with central nervous system involvement, involvement of the chiasm, optic nerve, hypothalamic-pituitary axis with panhypopituitarism (hypogonadism, hypocorticism, decreased growth and antidiuretic hormones).
+Treatment was started with methylprednisolone pulses 1g/d for 3 days, and vasopressin.
+At one and four years the patient was stable and hormonally controlled. The CV alterations were permanent but stable and non-progressive.
+
+VA was 1 in AO and the fundus showed a slightly verticalised papilla with pallor in the temporal region accompanied by peripapillary atrophy in OD and total pallor and temporal peripapillary atrophy in OI, physiological AO excavation. OCT showed a decrease in the nerve fibre layer in the upper, nasal and lower quadrant in OD and in all sectors of the OI. The visual evoked potentials with damer (PVE-pattern) showed a decrease in all recorded responses and a slight increase in latencies when stimulating the RO.
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