"Did you see it? Where did it go?"

doi:10.1136/bmj.39406.712743.AD

BMJ 2007;335:1284 (22 December), doi:10.1136/bmj.39406.712743.AD

Sport

"Did you see it? Where did it go?"

David E Price, consultant endocrinologist¹, Robert M Redfern, consultant neurosurgeon²

¹ Department of Endocrinology, Morriston Hospital, Swansea SA6 6NL, ² Department of Neurosurgery, Morriston Hospital, Swansea SA6 6NL

Correspondence to: R M Redfern robert.redfern{at}swansea-tr.wales.nhs.uk

On his 50th birthday an apparently fit man was presented witha special shirt by his regular golfing partners. In recognitionof his increasing inability to follow his ball if it strayedoff a line straight up the fairway, his gift was suitably inscribed.Some months later, at a routine visit to his optician, a bitemporalhemianopia was discovered. Radiological examination showed opticchiasmal compression resulting from suprasellar extension ofa pituitary adenoma.[f1]

The tumour was removed via a direct transnasal transsphenoidalapproach to the sella. Within a few hours of surgery his visualfield defect had fully recovered on clinical testing. When hewas last seen in outpatients his golf handicap had improvedfrom 18 to 14.

As this case shows, visual symptoms resulting from lesions inthe region of the optic chiasm characteristically develop insidiously,¹² and visual defects are often advanced by the time of diagnosisof the underlying compressive cause. None the less, chiasmaldecompression may be followed by dramatic and rapid visual recovery.

Contributors: Both authors managed the patient in a combinedclinic, and both contributed equally to the writing of the article.

Competing interests: Neither author plays golf, but DEP ownsa golfing sweater and RMR once got a hole in one.

Provenance and peer review: Not commissioned; not externallypeer reviewed.

References

Moore KP, Wass JAH, Besser GM. Late diagnosis of pituitary and parapituitary lesions causing visual failure. BMJ 1986;293:609-10.[Free Full Text]
Alleyne CH Jr, Newman NJ. Neuro-ophthalmology of pituitary tumours. In: Krisht FA, Tindall GT, eds. Pituitary disorders: comprehensive management. Baltimore, MD: Williams and Wilkins, 1999.