J.ophthalmol.(Ukraine).2019;1:46-51.

Received: 17 November  2018; Published: 28 February 2018 

Neuro-ophthalmological symptoms in pituitary apoplexy

K.S. Iegorova, Cand Sc (Med); M.O. Guk, Dr Sc (Med); O.Ie. Skobska, Dr Sc (Med); L.V. Zadoianyi, Cand Sc (Med)

Romodanov Neurosurgery Institute; Kyiv (Ukraine)

E-mail:  iegorova_katya@ukr.net

Background: Neuro-ophthalmological symptoms in patients with pituitary apoplexy were subjected to analysis. Impaired circulation in pituitary adenoma causes an atypical clinical course of the disease which makes the early diagnosis and provision of medical care difficult. Neuro-ophthalmological manifestations of the disease include loss of vision, visual field defects and oculomotor disturbances. Since the visual loss may present as unilateral or bilateral blindness, the field of this disease is of special importance.

Purpose: To investigate neuro-ophthalmological symptoms in patients with pituitary apoplexy before and after treatment.

Materials and Methods: Ninety patients with pituitary apoplexy were under surveillance at the Romodanov Neurosurgery Institute between 2014 and 2017. Of these, 44 patients (88 eyes) had visual loss and/or visual field defects, and were included in the main group of the study. Patients underwent clinical and neurological, neuro-ophthalmological, and otoneurological examination (including neuroimaging studies).

Results: Acute pituitary apoplexy (54.5% of patients) was characterized by sudden onset of presumably symmetric (50% of patients) chiasmal syndrome, and manifested by mildly or moderately impaired BCVA (39.6% of eyes) and sensitivity to light (60% of eyes), partial bitemporal hemianopia, oculomotor disturbances and absence of ophthalmoscopic changes. In addition, surgical treatment resulted in restoration of visual acuity and visual field in 27 (56.3%) eyes.

Subacute pituitary apoplexy (45.5% of patients) was characterized by a gradual development of chiasmal syndrome, with a history of sudden visual function loss, and by presumably severe or very severe visual acuity loss (65% of eyes), light sensitivity loss (67.5% of eyes), and development of primary descending optic nerve atrophy (70% of eyes). In addition, surgical treatment resulted in improvements in visual function in most (65%) eyes; however, compared with acute pituitary apoplexy, a complete restoration of visual function was less frequently observed (15%).

Conclusion: Pituitary apoplexy is one of the causes of acute visual loss in neurosurgical disorders. In acute pituitary apoplexy, early diagnosis and surgical treatment resulted in stabilization or improvement in visual acuity from 0.54±0.05 to 0.81±0.03 (p < 0.05), and improvement in visual field defects (as assessed by MD values) from 9.05±0.99 to 4.18±0.81 dB (p < 0.05).

Keywords: pituitary adenoma, pituitary apoplexy, chiasmal syndrome, optic nerve atrophy

References

  1. Simon S, Torpy D, Brophy B, Blumbergs P, Selva D, Crompton J.L. Neuro-ophthalmic manifestations and outcomes of pituitary apoplexy – a life and sight-threatening emergency. N Z Med J. 2011 May 27;124(1335):52-9.
  2. Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):542-5.
  3. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass J.A. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf). 1999 Aug;51(2):181-8.
  4. Turgut M, Ozsunar Y, Basak S, Guney E, Kir E, Meteoglu I. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir (Wien). 2010 May;152(5):749-61.
  5. Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg. 1981 Aug;55(2):187-93.
  6. Dubuisson AS, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg. 2007 Jan;109(1):63-70.
  7. Bonicki W, Kasperlik-Załuska A, Koszewski W, Zgliczyński W, Wisławski J. Pituitary apoplexy: endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir (Wien). 1993;120(3-4):118-22.
  8. Guk MO. [Diagnosis and treatment of non-functioning pituitary adenomas]. [Dr Sc (Med) dissertation]. Kyiv: Romodanov Neurosurgery Institute; 2017. 328 p. Ukrainian.
  9. Serova NK. [Clinical neuroophthalmology: Neurosurgical aspects]. Tver’: Triada Publishing House; 2011. Russian.
  10. Chuang CC, Chang CN, Wei KC, Liao CC, Hsu PW, Huang YC, Chen YL, Lai LJ, Pai PC. Surgical treatment for severe visual compromised patients after pituitary apoplexy. J Neurooncol. 2006 Oct;80(1):39-47.
  11. Bi WL, Dunn IF, Laws ER Jr. Pituitary apoplexy. Endocrine. 2015 Feb;48(1):69-75.
  12. Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ. Acute management of pituitary apoplexy – surgery or conservative management? Clin Endocrinol (Oxf). 2004 Dec;61(6):747-52.
  13. Agrawal D, Mahapatra AK. Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: A series of 14 eyes. Surg Neurol. 2005 Jan;63(1):42-6.
  14. Muthukumar N, Rossette D, Soundaram M, Senthilbabu S, Badrinarayanan T. Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci. 2008 Aug;15(8):873-9.