A 29-year-old man presented with peripheral vision alterations for several weeks, associated with manifestations of pituitary hypofunction.
The examination showed a visual acuity (VA) of 1 in both eyes (AO), with normal anterior pole, intraocular pressure and eye fundus (FO).
In the visual field (CV) (Octopus 1-2-3 G1X program), a superior arciform defect was observed with some peripheral alterations in the right eye (OD) and in the left eye (LE) defect was appreciated.
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Urine analysis revealed hypodensity of almost water and hormone functioning studies showed undetectable FSH and LH, testosterone and growth hormone levels below normal.
Magnetic resonance imaging (MRI) showed dilation of the left lateral ventricle, periventricular involvement of the third ventricle, of the hypothalamus, as well as of the region of the chiasm and of the optic nerves with contrast uptake.
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Contrast-enhanced computed tomography (CAT) revealed numerous cervical, bilateral supraclavicular, bilateral axillary, and thoracic and pelvic lymph nodes.
A deep axillary adenopathy was biopsied and the study was compatible with sarcoidosis.
The patient was diagnosed with systemic sarcoidosis with involvement of the central nervous system, involvement of the chyasma, optic nerve, hypothalamic-pituitary axis with panhypopituitarism (hypocorticogonadism, growth hormone decrease).
Treatment was initiated with methylprednisolone pulses 1g/d for 3 days, and with vasopressin.
After one year and four years, the patient was stable and hormone-controlled.
Changes in QoL were permanent although stable and without progression.
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The papilla was slightly vertical in the temporal region and in the eye fundus there was a papilla slightly verticalized with deformity in the temporal region accompanied by peripappil and in the temporal obstipation in the LE.
OCT showed a decrease in the fiber layer in the upper quadrant, nasal and lower quadrant in the right ear and in all sectors of the left eye.
Visual evoked potentials (VEP-pattern) showed a decrease in all recorded responses and a slight increase in latencies when stimulating OI.
