Clinical and Laboratory Findings and Visual Disorders in Patients with Macroprolactinoma

Abstract

Purpose: To describe the clinical and laboratory findings, and diagnosed visual disorders, in patients with macroprolactinoma.

Methods: Patients with an initial diagnosis of macroprolactinoma (13 subjects, 42±3.8 years old) were submitted to an endocrine evaluation, self-applied, regarding symptoms presented and records of basal prolactin at diagnose and 5 months after starting drug therapy. Ophthalmic evaluation including visual acuity, intraocular pressure and fundoscopy, Humphrey perimeter Visual Field Analyzer (HVF), and optical coherence tomography (OCT) with the use of the Fast RNFL Thickness and Fast Macular Thickness Map protocols. The data was analized by Wilcoxon’s test (p<0,05).

Results: The most frequent endocrine symptom among women were galactorrhea (66,7%), followed by amenorrhea (50%), and among men, loss of libido (71,4%). The median prolactin levels before treatment was 485 ng/mL, and after 5 months, 28,35ng/mL, with an average of 64,5ng/mL in women and 115,3 ng/mL in men (p<0,05). There were found 4 patients with chiasmal compression at diagnosis, according to the following: 1st) Had changes in HVF and OCT, but it could not be confirmed if these were caused by the macroprolactinomas; 2nd) No change in CVC and OCT, ruling out the latent visual defect diagnosis; 3rd) Presented probable compressions derived from the sequel, even with tumor regression and; 4th) had ophthalmic evaluation after 18 months of drug treatment, showing the classic pattern of band atrophy of the optic nerve, diffuse atrophy in right eye, diffuse thinning of macular thickness in left and right eye. However, the foveolar area was preserved.

Conclusions: Early diagnosis of visual disturbances caused by compression of the optic chiasm is extremely important, as such changes cause visual loss, potentially reversible if treated early.

Keywords: 744 tumors • 612 neuro-ophthalmology: diagnosis • 584 low vision