Pituitary adenoma. Preoperative symptomatology in a series of 260 patients.

Abstract

STUDY of the syndromes associated with pituitary adenoma began with the description of acromegaly by Marie (1886), and many reports of the symptomatology of the tumour have since appeared (Cushing, 1912;Cairns, 1935;Henderson, 1939;Jefferson, 1940;Bakay, 1950;Younghusband, Horrax, Hurxthal, Hare, and Poppen, 1952;Nurnberger and Korey, 1953; Mogensen, 1957;Ray and Patterson, 1962;Poppen, 1963). Recently a series of 260 patients with pituitary adenoma selected for combined surgery and radiotherapy because of failing vision has been studied. Both the effect of treatment on vision (Elkington and McKissock, 1967) and the subsequent endocrine function (Elkington, Buckell, Monamy, and Jenkins, 1967) have been described elsewhere. The present communication reports the pre-operative symptomatology in these patients and suggests how early diagnosis of pituitary adenoma, necessary if the best results are to be obtained from treatment, may be made on clinical grounds. Material and MethodsThe case records of 260 patients were examined. They had been operated on by one surgeon at either the National Hospital for Nervous Diseases, Queen Square, or Atkinson Morley's Hospital, Wimbledon, between 1938 and. The nature of the tumour had been confirmed by histological examination in 246; in fourteen the clinical and operative findings alone were accepted as diagnostic. Failing vision was the sole indication for operation in almost every instance, and detailed records of both the visual acuity and the visual fields were available. The former was expressed by Snellen or Jaeger reading type, and the latter was shown in charts of visual field obtained by perimetry. Quantitation of visual function using the method described by Colby and Kearns (1962) was not attempted, a simple descriptive classification being used for the visual fields. Evidence of endocrine function was not consistently recorded, and investigation of endocrine function was infrequent. FindingsOf the total of 260 patients, 145 were males and 115 females. The youngest patient was aged 14 years and the oldest 72 years at the time of operation. The greatest incidence of symptoms necessitating treatment occurred in the fifth decade in both sexes. Details of age, sex, and tumour type are given in Tables I and II (opposite).

Hemifield Slide Phenomenon as a Result of Heteronymous Hemianopia

“…5,6,11,12 Elkington described the preoperative symptomatology of patients with pituitary adenoma, and was the first to attribute the symptom to his patients' inability to correctly register an image in each eye. 13 In his series, 170 of 260 patients had bitemporal visual field loss and 84 of those (49%) complained of diplopia without having ocular palsy. 13 Hemifield slide is also possible with other heteronymous hemianopias.…”

“…13 In his series, 170 of 260 patients had bitemporal visual field loss and 84 of those (49%) complained of diplopia without having ocular palsy. 13 Hemifield slide is also possible with other heteronymous hemianopias. Borchert et al reported two patients in whom hemifield slide was attributed to heteronymous altitudinal visual field defects (those respecting the horizontal midline) from bilateral ischaemic optic neuropathy.…”

Criteria for early detection of temporal hemianopia in asymptomatic pituitary tumor

“…Visual field defects are thought to be due to the direct compression or the effect on the blood supply of the optic chiasm. These visual field defects can be detected by manual perimetry, 1 and by automated static perimetry.…”

Detection of Visual Field Loss in Pituitary Disease: Peripheral Kinetic Versus Central Static

“…As well as visual dysfunction, complications include the effects of hormone hypersecretion, hypopituitarism, headaches, and epilepsy. 2 The diagnosis of this type of lesion at an early stage is therefore of importance to the prognosis of the patient, particularly as early intervention is of known benefit. [3][4][5][6] The management of patients with pituitary tumours includes surgical and medical treatments, and both have been shown to be beneficial to patients with pituitary tumour in terms of preservation of vision and amelioration of visual dysfunction.…”

“…7 The typical field defects of bitemporal hemianopias and quadrantanopias are known to be associated with pituitary tumour, although other types of field defect have been described. [8][9][10][11][12][13] Elkington 2 reported visual field defects in 92.6% of his series, with the majority (70.7%) being varieties of bilateral temporal loss. Rowe and colleagues 14 reported visual field defects in 56% of their cases, with bilateral field loss being most frequent but a mix of temporal and nasal loss.…”