Ophthalmic findings in pituitary adenomas: a case-series of 100 patients

Abstract

Abstract

Purpose: Pituitary adenomas (PA) correspond to 10-15% of intracranial tumours, and are generally benign slow-growing tumours, associated with a wide range of clinical manifestations. Our aim was to characterize the ophthalmic findings and the utility of the ophthalmological multimodal exam, in the setting of pituitary adenoma.

Methods: retrospective case-series of 100 patients with PA. Clinical records were reviewed for demographics, presenting symptoms, hormonal activity, efficacy and safety of chosen treatment modality. Ophthalmic exam was recorded annually until 5-years of follow-up, including: visual acuity (VA), visual fields (VF), pupillary response (PR), ocular motility, and retinal nerve fibre layer RNFL thickness  (RNFLT) in optical coherence tomography (OCT).

Results: Mean age at diagnosis was 52-years [11-85]. Forty-seven patients were female. Mean ophthalmic follow-up was 47±38 months. Hormonal activity was present in 42.7% of cases (mostly prolactin production), and 48.3% were associated with ≥1 hormonal deficiency. Most common presenting symptoms were VF/VA defects (n=30), headache (n=29) and fatigue (n=13). Mean baseline VA was 0.8±0.3. Abnormal PR was found in 25 patients, and 6 had oculomotor defects. VF defects respecting the vertical meridian occurred in 49 patients, of which 20 (40.8%) initially reported visual disturbances. Baseline RNFLT was reduced in 37% (>90% with temporal atrophy). Imagiological tumour progression was accompanied by deterioration of the ophthalmic exam (visual function and/or OCT) in 50% of cases.

Conclusion: Though ophthalmic symptoms are frequent in the setting of PA, oftentimes the patient is unaware of visual disturbances. Collaboration with the ophthalmologist adds value to the management of these patients.