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).

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.

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.