Giant prolactinoma mimicking low-tension glaucoma at presentation

Karl, David; Gillan, Stewart; Goudie, Colin; Sanders, Roshini

doi:10.1136/bcr-2014-207634

Cited by 7 publications

(5 citation statements)

References 3 publications

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“…Therefore, the sensitivity and generalisability of the mNTR in early-stage patients without visual symptoms are still to be established. Patients with optic nerve changes due to chiasmal compression are sometimes initially thought to have glaucoma 34 35 and the mNTR may be a particularly valuable diagnostic tool in this population.…”

Section: Discussionmentioning

confidence: 99%

Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio

et al. 2023

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Background/aimsThe analysis of visual field loss patterns is clinically useful to guide differential diagnosis of visual pathway pathology. This study investigates whether a novel index of macular atrophy patterns can discriminate between chiasmal compression and glaucoma.MethodsA retrospective series of patients with preoperative chiasmal compression, primary open-angle glaucoma (POAG) and healthy controls. Macular optical coherence tomography (OCT) images were analysed for the macular ganglion cell and inner plexiform layer (mGCIPL) thickness. The nasal hemi-macula was compared with the temporal hemi-macula to derive the macular naso-temporal ratio (mNTR). Differences between groups and diagnostic accuracy were explored with multivariable linear regression and the area under the receiver operating characteristic curve (AUC).ResultsWe included 111 individuals (31 with chiasmal compression, 30 with POAG and 50 healthy controls). Compared with healthy controls, the mNTR was significantly greater in POAG cases (β=0.07, 95% CI 0.03 to 0.11, p=0.001) and lower in chiasmal compression cases (β=−0.12, 95% CI −0.16 to –0.09, p<0.001), even though overall mGCIPL thickness did not discriminate between these pathologies (p=0.36). The mNTR distinguished POAG from chiasmal compression with an AUC of 95.3% (95% CI 90% to 100%). The AUCs when comparing healthy controls to POAG and chiasmal compression were 79.0% (95% CI 68% to 90%) and 89.0% (95% CI 80% to 98%), respectively.ConclusionsThe mNTR can distinguish between chiasmal compression and POAG with high discrimination. This ratio may provide utility over-and-above previously reported sectoral thinning metrics. Incorporation of mNTR into the output of OCT instruments may aid earlier diagnosis of chiasmal compression.

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Section: Discussionmentioning

confidence: 99%

Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio

et al. 2023

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“…U pacienta bol diagnostikovaný normotenzný glaukóm pre normálne hodnoty vnútroočného tlaku a exkavácie na TZN. Pri detailnejšom vyšetrení bol zistený obrovský prolaktinóm [12]. Ahmed preukázal, že až 6,5 % pacientov s diagnózou normotenzný glaukóm mali v jeho súbore klinicky relevantnú kompresiu zrakovej dráhy [13].…”

Section: Kazuistikaunclassified

Giant Prolactinoma. A Case Report

Šulavíková¹,

Krásnik²

2023

CSO

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Aim: Prolactinoma is a pituitary adenoma that secretes prolactin. Approximately 40% of all pituitary adenomas are prolactinomas. According to size, they are divided into micro, macro and giant prolactinomas. In women, prolactinomas cause irregularities of the menstrual cycle such as amenorrhea, galactorrhea, weight gain, in both sexes they cause sterility, hypogonadism, decreased libido and depression. In macroadenomas, symptoms due to the compression of the surrounding structures are also manifested, such as headache, vomiting, lower chiasmatic syndrome and ophthalmoplegia. Loss of the visual field due to compression of the optic chiasm is caused by a tumor larger than 10–15 mm with suprasellar spreading, which breaks through the diaphragma sellae. Giant prolactinomas are larger than 40 mm and make up 1–5% of all prolactinomas. Case report: In this article I present the case of a 38-year-old woman from Ukraine with advanced chiasmatic syndrome caused by a giant prolactinoma. The tumor is infiltrating the left cavernous sinus, causing left-sided amaurosis and right-sided temporal hemianopsia. Conclusion: Inferior chiasmatic syndrome is characterized by bitemporal hemianopsia, a deterioration of visual acuity, bilateral bow-tie descendent atrophy of the optic nerve disc, and hemianopic rigidity of the pupils. Macroprolactinomas occur more frequently in men than in women. The diagnosis is often delayed, probably because the symptoms of hyperprolactinemia are less obvious in men, while women tend to present earlier due to menstrual cycle irregularities. Prolactinomas usually have a good prognosis. Effective medical treatment with dopamine agonists is available. Knowledge of the prolactinoma symptoms could help the diagnosis of compressive lesions of the optic chiasm.

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“…Patients with intracranial tumors have been reported to have normal IOP but glaucomatous-like optic discs. [3][4][5][6] Studies show that the neuroradiological presence of a mass lesion in patients diagnosed with glaucoma varies from 0 to 14.2%. 2,7 While part of the possible work-up, routine neuroimaging is not recommended for patients with presumed NTG, because of the low yield of intracranial pathological detection.…”

Section: Introductionmentioning

confidence: 99%

Pituitary Macroadenoma with Optic Cupping Masquerading as Normal Tension Glaucoma

Cheng¹,

Schecter²,

Komotar³

et al. 2023

IMCRJ

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When non-glaucomatous disease with disc cupping mimics normal-tension glaucoma (NTG), diagnosis is challenging. The typical optic disc features of glaucomatous disease are often subjective, and often overlap with disc changes in compressive intracranial lesions. Ancillary diagnostic testing such as retinal nerve fiber layer (RNFL) analysis and visual field testing can elevate the index of suspicion of an underlying non-glaucomatous process. We present a case of a nonfunctional macroadenoma coexisting with NTG, although it is unclear if the concurrent brain lesion aggravated or caused it. This case highlights the diagnostic challenge of recognizing optic cupping and non-matching abnormalities in the visual field from a coexisting intracranial lesion, even in the absence of other neurological signs.

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Giant prolactinoma mimicking low-tension glaucoma at presentation

Cited by 7 publications

References 3 publications

Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio

Differentiating glaucoma from chiasmal compression using optical coherence tomography: the macular naso-temporal ratio

Giant Prolactinoma. A Case Report

Pituitary Macroadenoma with Optic Cupping Masquerading as Normal Tension Glaucoma

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