The Role of the Visual Evoked Potentials in Diagnosing and Monitoring Pituitary Adenomas

Popescu, Mihaela; Cârșote, Mara; Popescu, Iulian Alin Silviu; Costache, Andrei; Ghenea, Alice Elena; Turculeanu, Adriana; Singer, Cristina Elena; Iana, Oana; Ungureanu, Anca

doi:10.38173/rst.2021.21.1.3:27-38

Cited by 2 publications

(5 citation statements)

References 6 publications

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“…Chronic excess of GH and IGF1 (Insulin-like Growth Factor 1) has dramatic consequences concerning cardio-metabolic parameters (high blood pressure, glucose and lipid profile anomalies, left ventricular hypertrophy, diastolic, systolic and endothelial dysfunction, and even heart failure), cosmetic features (course facial and acral enlargement), respiratory aspects (sleep apnea), muscular-skeletal issues (arthropathy, osteoporosis and fragility fractures, especially vertebral fractures) and a selective oncologic risk (colonic cancer), causing an increased morbidity and mortality with a massive impairment of quality of life [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Approach of Acromegaly during Pregnancy

et al. 2022

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Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10–80%), and negative effects of glucose profile (GP) anomalies (10–70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5–15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7–50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT+ve and PT-ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.

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Section: Introductionmentioning

confidence: 99%

Approach of Acromegaly during Pregnancy

et al. 2022

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“…Among functional tests, VEP has been extensively used regarding latency, which reflects conduction velocity along the demyelinated segment of nerve fibers, which is the biomarker of choice. Previous studies have considered the VEP P100 latency as a diagnostic marker of early functional changes in the visual pathway before the appearance of other clinical features in PMA ( Popescu et al, 2021 ). VEP represents an extension of clinical examination but is not routinely performed in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…The evaluation of visual function using VEP offers an alternative for the characterization and personalized management of patients with PMA ( Taghvaei et al, 2019 ; Popescu et al, 2021 ). VEPs objectively assess the function of the optic nerve and chiasm and eliminate patient-dependent subjectivity and cooperation factors that affect automatic perimetry ( Taghvaei et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

“…VEPs objectively assess the function of the optic nerve and chiasm and eliminate patient-dependent subjectivity and cooperation factors that affect automatic perimetry ( Taghvaei et al, 2019 ). In clinical practice, the positive wave P100 is frequently analyzed because it is constant and easy to identify ( Popescu et al, 2021 ). According to Lachowicz and Lubiński, pattern VEPs are objective, reproducible, and more sensitive than other classical VEPs or psychophysical tests of visual function ( Lachowicz and Lubiński, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…In patients with PMA, detecting early visual pathway dysfunction may modify medical or surgical treatment and reduce the incidence of irreversible optic nerve damage ( Lachowicz and Lubiński, 2018 ). In theory, VEP could represent an extension of the clinical examination, but they are not yet routinely performed ( Lachowicz and Lubiński, 2018 ; Taghvaei et al, 2019 ; Popescu et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Bi-nasal sectors of ganglion cells complex and visual evoked potential amplitudes as biomarkers in pituitary macroadenoma management

Hernández-Echevarría¹,

Cuétara-Lugo²,

Pérez-Benítez³

et al. 2022

Front. Integr. Neurosci.

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The study aimed to evaluate the retinal ganglion cell structure using optical coherence tomography and the visual pathway function employing visual evoked potentials in the diagnosis and monitoring of patients with pituitary macroadenoma. A descriptive, cross-sectional, and longitudinal study (3 and 12 months follow-up) was conducted on forty-two patients. Thirty-five age-matched healthy controls were used in the cross-sectional one. Full neuro-ophthalmological evaluation (structural and functional) was carried out including global and segmented retinal nerve fiber layer/ganglion cell complex analysis and amplitude and latency of P100 component in the electrophysiology. Statistical data analysis was conducted with R version 3.6.3 and Python version 3.8. Associations were evaluated using Spearman’s correlations. Amplitude sensitivities were 0.999, and bi-nasal sectors of ganglion cell complex thickness specificities were 0.999. This structural parameter had the highest diagnostic value (area under curve = 0.923). Significant associations were found between bi-nasal sectors with amplitude at 12′ (rho > 0.7, p < 0.01) and median deviation of the visual field (rho > 0.5, p < 0.01) at 3 months. Pre-surgical values of bi-nasal sectors and amplitude can predict post-surgically median deviation and amplitude (Oz, 12′) at 3 months with r2 > 0.5. Bi-nasal sectors of ganglion cell complex and visual evoked potentials P100 amplitude are efficient biomarkers of visual pathway damage for pituitary macroadenoma patients’ management. Pre-surgical values of the bi-nasal sector and visual evoked potentials’ amplitude could help to predict the restoration of parvocellular pathway traffic after decompression.

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The Role of the Visual Evoked Potentials in Diagnosing and Monitoring Pituitary Adenomas

Cited by 2 publications

References 6 publications

Approach of Acromegaly during Pregnancy

Approach of Acromegaly during Pregnancy

Bi-nasal sectors of ganglion cells complex and visual evoked potential amplitudes as biomarkers in pituitary macroadenoma management

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