Neuro-ophthalmologic exploration in non-functioning pituitary adenoma

Abstract

Non-functioning pituitary adenoma may lead to blindness and causes visual impairment in 58% of cases and, more rarely, ocular motor disorder. Patients are slow to become aware of their visual dysfunction, vision in one eye compensating the deficit in the other. Assessment of visual function, comprising visual acuity and visual field evaluation and fundus examination, should be performed regularly according to the severity of impairment. Optic nerve optical coherence tomography (OCT) can quantify optic atrophy reproducibly, and is of prognostic value for postoperative visual recovery. Diplopia most often involves decompensation of heterophoria, visual field fusion being hampered by the visual field defect; such diplopia without ocular motor deficit is known as "hemifield slide". Diplopia associated with ocular motor palsy is caused by tumoral invasion of the cavernous sinus (IIIrd, IVth or VIth nerve palsy); in large impairment, restricted eye movement is easily observed; milder palsies require neuro-ophthalmologic assessment and/or Lancaster test. Pituitary apoplexy induces ocular motor impairment in 70% of cases, strongly guiding diagnosis. Visual impairment is associated in 75% of cases. The degree of neuro-ophthalmologic (visual and ocular motor) impairment is one of the main criteria guiding treatment of pituitary apoplexy (conservative medical and/or surgical treatment) and follow-up.

ICAR: endoscopic skull‐base surgery

“…Ocular motility and alignment examination to test movement eye‐by‐eye and conjoint movement, as well as cover test measuring the deviation with prisms and pupil examination is the standard examination for CN injury testing …”

A Case of Giant Pituitary Adenoma Associated with a Postoperative Mental Disorder That Ultimately Resulted in Bilateral Blindness

“…At the time of recurrence, the tumor in the present case was a giant nonfunctioning pituitary adenoma, and a nonfunctioning pituitary adenoma is more common in men and often occurs at youth and middle age [19]. Since there are no symptoms due to excessive hormone secretion, patients often have a very large tumor at the time of recurrence [20]. Symptoms include bitemporal hemianopia due to direct compression of the optic chiasm just above the pituitary gland by the tumor.…”

Pituitary adenoma: a literature review

“…Re gos su tri ki mai, prie ðin gai, pri klau so nuo na vi ko dy dþio ir au gi mo kryp ties -HA ga li spaus ti re gos ner vø kryþ mae, gal vi nius ner vus (akies ju di na mà já, skri dini ná, ati trau kia mà já) [10,44]. Daþ niau si re gos simp to mai: bi tem po ra li në he mia nop si ja (54-69 %), ki ti aki plo èio sutri ki mai (85 %), su ma þë jaes re gos aðt ru mas (42-88 %) [10,44,46].…”

“…Vis gi, kai ka da net ir la bai ma þos na vi ki niø làs te liø san kau pos, ku rias sun ku ar net ne áma no ma pa ste bë ti vi zu a li niuo se ty ri muo se, ga li su kel ti kli nið kai ak ty vø sin dro mà, pa vyz dþiui, ser gant Ku ðin go liga, MRT be po ky èiø bû na 40 % at ve jø [1]. La bai svar bu yra of tal mo lo go kon sul ta ci ja ir re gos funk ci jos ið ty ri mas, net ir ne pa si reið kus jos su tri ki mams, nes pa leng va pro gresuo jan èiø simp to mø (pvz., bi tem po ra li nës he mia nop si jos) pa cien tas ga li ne pa ste bë ti [10,46]. Re ko men duo ja ma atlik ti ir op ti nae ko he ren ti nae to mog ra fi jà, nes, jei HA spaudþia re gos ner vo kryþ mae, dël ak so nø de ge ne ra ci jos plo në ja re gos ner vo dis ko skai du los [44].…”