Abstract: Pituitary metastasis (PM) from clear cell renal cell carcinoma (ccRCC) has a rare occurrence of constituting only 0.03%–0.05% of all pituitary tumors. The patient, a 58-year-old man with a history of bilateral ccRCC and endocrine disorders, presented with progressive visual deterioration and headaches. Initial ophthalmological examination revealed a unilateral inferior altitudinal visual field defect, contrasting with typical PM cases. Brain magnetic resonance imaging and computed tomography exposed a large suprasellar lesion with a unique relationship to surrounding structures, notably the left A1 segment of the anterior cerebral artery. Surgical removal confirmed invasive ccRCC metastasis, addressing hormone dysregulation. The distinctive manifestation of a prechiasmal optic nerve compression resulting in an unusual visual field defect underscores the need for ophthalmologists to consider brain lesions in unexplained visual impairments. This case contributes novel insights into the complex interplay between PM and adjacent anatomical structures.
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