[Glaucoma in central hypothalamic-hypophyseal Cushing syndrome]

One third of a general population reacts to exogenously applied corticosteroids with an increase of intraocular pressure. In this study we investigated the influence of endogeneously elevated serum cortisol levels on the intraocular pressure and the presence of glaucomatous changes in the morphology of the optic disc and retinal nerve fiber layer. 15 patients with hypothalamic-pituitary Cushing's disease due to an ACTH producing adenoma of the pituitary gland and undergoing transphenoidal microsurgical exploration of the sella turcica were ophthalmologically examined pre- and post-operatively. Subjective symptoms had been noticed not earlier than four years before operation. Intraocular pressure was preoperatively and postoperatively within the normal range for all but one patient with readings of 23/23 mm Hg preoperatively. In the subgroup with endocrinological remission the intraocular pressure readings decreased postoperatively. Photography of the retinal nerve fiber layer, morphometry of 15 degree color stereo optic disc diapositives, and perimetry revealed no changes typical for glaucoma. In 4 patients the retinal nerve fiber bundles were remarkably well visible. We conclude that patients suffering from hypothalamic-pituitary Cushing's disease with endogeneously elevated serum cortisol levels and a duration of subjective symptoms of less than 4 years run a lower risk of developing glaucomatous damage than patients with topical administration of corticosteroids.