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Peter W. MacIntosh, Augustine Hong, Lee Katzman, Omar Al-Heeti, Richard Ahuja, Jeffrey Nichols; Visual Symptoms And Field Defects In Patients With Pituitary Adenomas At Presentation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):261.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the presenting visual symptoms and visual field defects in patients with pituitary adenomas.
A retrospective review of patients with pituitary tumors who presented to Stroger Hospital of Cook County Division of Ophthalmology from 2004 to 2010. All patients had an eye exam including Humphrey Visual Fields (HVF) 24-2 and MRI of the brain. Quantification of the HVF mean deviation in each quadrant was performed.
A total of 114 patients were screened. Thirty-two were new presentations and included in the study. The others were excluded because they were diagnosed elsewhere and/or previously treated medically or surgically. There were 18 males and 14 females. The mean age was 46 years (SD ± 17 years, range 18-75). Of the 32 patients, six (19%) had microadenomas and 18 (56%) had visual complaints. Most presented within 6 months of symptom onset, but a few presented as late as 5 years after symptoms began. The most common symptoms were blurry vision and/ or headache, each reported by 9 (28%) patients at presentation. Three (9%) complained of visual field loss at presentation. Less than 5% complained of other symptoms. The fourteen patients (44%) that had no visual complaints at presentation had their adenomas diagnosed by imaging for either endocrine symptoms or incidentally for other reasons. Twenty-one of the 32 patients had reliable HVF and were included in the HVF analysis. Twelve (57%) of these presented with abnormal HVF and nine (43%) had at least mild bitemporal hemianopsia, the most common visual field defect. Five (42%) of the patients with abnormal visual fields had no presenting visual complaints. Nine (43%) patients in the analysis had full HVF upon presentation. Of those with full HVF, six (66%) had no visual complaints, two complained of headache and one had ill-defined complaints.
In this study, almost half of patients with pituitary adenomas did not have any presenting visual symptoms. Of the patients who were visually symptomatic, blurry vision and headache were the most common presentations, each reported by 28% of patients. The visual field analysis showed 43% of patients with adenomas had full HVF and two-thirds of these patients had no visual complaints. Bitemporal hemianopsia was the most common presenting HVF defect. We plan to continue this study by enrolling 1000 patients both pre and post-treatment to better understand the presentation and course of pituitary adenomas.
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