Ming Chen,1 Charissa Tan,1 Corey Nishimura1
1 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
We present a 73-year-old female immigrant from Philippine who was followed by author continuously for 17 years. Records reviewed that her IOP was 19/21 in 2015, and Retina Nerve Fiber Layer (RNFL) were 99/83. Glaucoma and cataract were diagnosed. Since then, subsequent Xalatan eye drops, Selective Laser Trabeculoplasty (SLT), cataract surgery, even Xen implant was provided to patient due to spiking IOP from time to time with arcuate visual field defect and thinner RNFL. Pituitary tumor was not suspected until 2020 despite visual field progress to suspicious bitemporal defect while IOP were controlled at 14mmHg. In 2025 when eye exam showed pale disc with MG pupil over left side then MRI was ordered. MRI confirmed a 2.2 cm adenoma compress on optic chiasma and left optic nerve atrophy.The vision was 20/40 right eye and 20/100 left eye.The Patient was referred to a neurosurgeon for surgery.
We report this case to alert the higher incidence of pituitary tumor in pacific islanders such as Hawaii residents. There is no study to reveal the specific incidence of pituitary tumor in Hawaii. However, one study showed there was 6.8 % of pituitary tumor in all the brain tumor in Hawaii, while Pacific Islanders had higher proportion.
Any unusual glaucoma cases should be carefully studied to rule out pituitary tumors, especially in younger patients without symptoms. Careful visual field review and optic nerve examination are essential.Early diagnosis and surgery can prevent losing sight and sometimes can reverse vision loss. In this case the author did not know pituitary tumors are not uncommon in Hawaii and only focused on glaucoma and cataract treatment.
