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Quiz: When Colour Faded First

Test your understanding of this case with 10 questions.

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Case Information
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PATIENT DEMOGRAPHICS

44-year-old male

PRESENTING COMPLAINT

Gradual, progressive blurring and dimming of vision in the left eye over several months. Specifically reports that colours appear washed out and less vivid in the left eye compared to the right. No pain, no diplopia, no headache volunteered.

EXAMINATION FINDINGS

Visual Acuity: OD: 6/6. OS: 6/60

Pupils: Left relative afferent pupillary defect (RAPD) present

Fundus: Optic discs — see OCT. Colour vision (Ishihara) OS: 1/15 (severely reduced). Visual field: left inferior altitudinal field loss.

INVESTIGATIONS

Automated perimetry printout showing dense left inferior altitudinal field loss

Automated perimetry printout showing dense left inferior altitudinal field loss

Visual Field Testing: Left eye demonstrates dense inferior altitudinal field loss.

OCT optic disc analysis showing reduced average RNFL thickness in the left eye (77μm) with 75% symmetry

OCT optic disc analysis showing reduced average RNFL thickness in the left eye (77μm) with 75% symmetry

OCT Optic Disc Analysis: Average RNFL Thickness: OD 104μm, OS 77μm. RNFL Symmetry: 75%. Rim Area: OD 1.62mm², OS 1.77mm². Disc Area: OD 2.06mm², OS 2.18mm². Average C/D Ratio: OD 0.46, OS 0.43. Vertical C/D Ratio: OD 0.47, OS 0.56. Cup Volume: OD 0.070mm³, OS 0.038mm³. Established RNFL thinning in the left eye, consistent with a left optic neuropathy.

Coronal MRI demonstrating a cystic pituitary adenoma with eccentric extension compressing the left optic nerve

Coronal MRI demonstrating a cystic pituitary adenoma with eccentric extension compressing the left optic nerve

Sagittal MRI demonstrating the cystic pituitary adenoma in the sellar/suprasellar region

Sagittal MRI demonstrating the cystic pituitary adenoma in the sellar/suprasellar region

Neuroimaging (MRI, coronal and sagittal views): Demonstrates a cystic pituitary adenoma causing compression of the left optic nerve.

Question 1 of 10

Given the likely diagnosis, which additional history should specifically be sought that isn't yet documented?

Question 2 of 10

What is the clinical significance of the severely reduced Ishihara score (1/15) in the left eye?

Question 3 of 10

Which feature of this presentation is atypical for the "classic" teaching pattern of chiasmal compression from a pituitary mass?

Question 4 of 10

The OCT shows an average RNFL thickness of 77μm in the left eye versus 104μm in the right, with 75% symmetry. What does this indicate?

Question 5 of 10

What is the most likely diagnosis?

Question 6 of 10

Why might a pituitary mass compress one optic nerve preferentially, producing a unilateral rather than bitemporal pattern?

Question 7 of 10

Beyond MRI, what additional investigation is a standard part of the work-up for a newly diagnosed pituitary adenoma?

Question 8 of 10

Which acute presentation should prompt urgent concern for pituitary apoplexy in a patient with a known pituitary adenoma?

Question 9 of 10

What is the most appropriate management approach for this patient?

Question 10 of 10

A colleague assumes this patient cannot have a pituitary adenoma because the field loss isn't bitemporal. How would you respond?