Introduction Long term usage of medroxyprogesterone acetate warrants consideration of neurological imaging due to its high-rate association with meningioma growth. Often, meningioma associated with progestin therapy occurs in the anterior and middle cranial skull base in close proximity to the visual pathway. Herein we describe a case of visual decline as an initial symptom that led to the discovery of an anterior clinoidal meningioma. Case Report A 55-year-old Black female presented with visual decline for 6 months with history of medroxyprogesterone use for greater than 5 years. She was found to have reduced visual acuity, constricted fields, and optic atrophy of her right eye. Magnetic resonance imaging revealed an anterior clinoidal meningioma extending onto and compressing the right optic nerve. Conclusion Certain progestin therapies, including medroxyprogesterone acetate, are associated with increased risk of meningioma growth. Regular ophthalmic monitoring with a low threshold for ordering neuroimaging is warranted in patients undergoing hormonal therapy.
Feng et al. (2026) studied this question.