PMC10368096_01
Goldmann visual field test. Red outlines indicate the visual field range. a Visual field showing right-eye blindness before T-DXd administration. b Visual field showing right-eye improvement after six doses of T-DXd.
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F1
Vision in the right eye was almost lost (Fig. 1a) with indirect light reflection and no direct contralateral light reflection 1 month before the start of T-DXd treatment. T-DXd (Fig. 1b), and the response was confirmed by MRI after the sixth dose (Fig. 2b). The 25th dose was administered in December 2022.
a Brain MRI before T-DXd administration. Multiple BMs were observed mainly in the pituitary gland, right occipital lobe, left parietal lobe, and cerebellum (yellow arrows). b Brain MRI showing tumor shrinkage after six doses of T-DXd. Treatment response was classified as partial response with RECIST guidelines (version 1.1).
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F2
BM (Fig. 2a) and that visual impairment was caused by optic nerve compression from the pituitary metastases. Blood tests to evaluate pituitary dysfunction revealed the following concentrations: thyroid stimulating hormone was 0.041 mIU/L (normal range; 0.37-4.2 mIU/L), free thyroxine was 0.09 pmol/L (normal range; 0.09-0.19 pmol/L), cortisol was 1.0 mug/dL (normal range; 4.5-21.1 mug/dL), and growth hormone was 0.70 ng/mL (normal range; 0.13-9.88 ng/mL).