Connecting our world at UW Medicine

Julie Hartley’s story: A baffling case of vision loss

Julie Hartley, a 64-year-old lawyer, was not overly concerned when she began to feel more tired than usual. She attributed her loss of energy to getting older, and she talked with her primary care provider about exercising more.

Several months later, she went back to her doctor when she started noticing changes in her vision. Although she could see clearly with both eyes open, she had tunnel vision when either eye was closed. She also began seeing double letters in words on her computer screen.

A referral to an ophthalmologist revealed more problems. On the standard eye chart test, she could only read two letters on each line. More in-office tests followed, but the medical team was uncertain as to the cause of her condition. As the days passed, she was referred to another eye specialist who performed further inconclusive testing. When referred to yet another eye clinic, technicians performed a visual field test, which is usually ordered when doctors suspect glaucoma. In this test, the patient looks into the center of a bowl-shaped instrument and presses a button whenever small, dim lights become visible.

Hartley’s visual field test results were so unusually poor that the technicians stopped midway, asserting that she was perhaps simply not cooperating with the testing. Fortunately, the doctor instructed the technicians to repeat the visual field test to its conclusion. This time, Hartley received a shocking diagnosis. Her symptoms were consistent with a pituitary tumor. The doctor reassured her, however, that pituitary tumors are usually benign and treatable.

Located at the base of the brain and about the size of a kidney bean, the pituitary gland is considered the “master gland” of the body because it regulates many activities of other endocrine glands.

When an MRI confirmed that Hartley had a large (3-centimeter) pituitary tumor, her primary care doctor had one more referral: Hartley needed to go to UW Medicine immediately to see Dr. Manuel Ferreira Jr., chief of neurosurgery at UW Medical Center and surgical director of the UW Medicine Multi-Disciplinary Pituitary Program, part of the UW Medicine Neurosciences Institute.

“UW Medicine has the most comprehensive center for pituitary disorders in the WWAMI region, and one of the largest in the country,” said Ferreira. “Pituitary tumors are the most common of these disorders. They occur in about 10% to 12% of the population, and a primary symptom is vision loss.”

The Friday that her referral was received, Ferreira arranged to see Hartley for an assessment with his colleagues, UW Medicine head and neck surgeon Dr. Kris Moe and UW Medicine endocrinologist Dr. Anthony DeSantis.

They determined that the tumor needed to be removed quickly because it was pressing on Hartley’s optic nerves, which could have caused irreversible eyesight damage. The surgical approach for removing a pituitary tumor depends on its size and location. It can be done through the nose, through an incision under the upper lip or through the skull.

The following Monday, Ferreira and Moe removed the tumor using the most common procedure: endoscopic transnasal transsphenoidal surgery. In this minimally invasive procedure, the otolaryngology team navigates an angled endoscope with a built-in video camera into the sinus cavity located beneath the pituitary gland. The neurosurgeon then removes the thin bone beneath the gland, opens the coverings of the gland and removes the tumor.

Hartley went home the day following her surgery. She says her vision was quickly restored, and she has experienced no complications.

For Ferreira, this is exactly how the UW Medicine program is meant to work. “From fast access to excellent outcomes, our team provides treatments for pituitary disorders that are not found anywhere else in the community.”

Hartley is a very appreciative patient. “Everything is back to normal,” she said. “I even have more energy.”

Learn more about the UW Medicine Pituitary Program.

 

Recent Posts