MANAGEMENT OF ENDOCRINE DISEASE: Visual morbidity in patients with pituitary adenoma

Abstract

Visual dysfunction is an important element in the morbidity encountered in patients with pituitary adenoma leading to functional impairment and compromised quality of life. It consists of many parameters (even in the absence of reported symptomatology) as a result of tumour growth in proximity to structures critical for vision (anterior visual pathway, cranial nerves within cavernous sinuses), and as an adverse consequence of therapeutic interventions. Adenoma resection leads to high rates of visual improvement and possibly continues beyond a year post surgery, but the exact timing of maximum effect requires elucidation. Retinal nerve fibre layer measurement may be a reliable, objective parameter predicting favourable visual outcomes, although its prognostic value when pathological, needs to be confirmed. For compromised vision after pituitary apoplexy, early surgical decompression remains usual practice until evidence-based guidance becomes available. The risk of radiation-induced visual toxicity is mainly influenced by total and per fraction dose of radiation and treatment modality. Careful selection of cases and of radiotherapy technique/planning are of major importance in minimising this risk. Dopamine agonists lead to visual recovery in a considerable number of prolactinoma patients. Visual morbidity should be considered a vital indicator in the metrics of quality of service/care in pituitary disease making regular, full ophthalmic examination an essential component of modern management of pituitary pathology at all time points of patient pathway. Well-designed studies minimising effects of bias and using tools and scoring systems reliably reflecting visual status will provide robust evidence on valid prognostication and patient stratification guiding clinical decision making.

Quality of care evaluation in non-functioning pituitary adenoma with chiasm compression: visual outcomes and timing of intervention clinical recommendations based on a systematic literature review and cohort study

“…In the current management of pituitary adenomas, an optimal ophthalmological examination is paramount to ensure optimal timing of treatment [12]. Two main examinations for proper patient stratification are the evaluation of VFs and VA. As exemplified by Fig.…”

“…The clinical relevance of prevention of visual morbidity as a benchmark for quality of care in pituitary adenoma patients is highly acknowledged [12]. The aim of this manuscript is to provide clinical recommendations for timing of surgical decompression, based on best available evidence and with a new approach to use MD to improve objective reporting of VFDs severity.…”

Differential non-coding RNAs expression profiles of invasive and non-invasive pituitary adenomas

“…A total of 15 patients were classified into the non-invasive pituitary tumor group while the other 15 were classified into the invasive adenoma group. Invasive PAs were defined as Hardy–Wilson classification grade III-IV and Knosp classification grades III-IV [ 1 , 2 ] ( Fig. 1 A, Fig.…”

“…Pituitary adenomas (PAs) are benign, typically slowly progressing tumors of the adenohypophysis and represent 10–15% of all intracranial tumors, occurring in almost 20% of the general population [ 1 ]. Despite their benign nature, PA often shows invasive growth.…”

Amenorreia secundária: revisão das etiologias / Secondary amenorrhea: etiologies review

“…A sintomatologia pode ser derivada da produção hormonal ou dos efeitos de massa intracraniana. (LITHGOW et al, 2019).…”