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Published on: January 17, 2018
Neuro-ophthalmologic exploration in non-functioning pituitary adenoma
Lucie Abouaf1, Alain Vighetto1, Maud Lebas2
1Unité de neuro-ophtalmologie, service de neurologie D, hôpital neurologique, hospices civils de Lyon, groupement hospitalier Est, 59, boulevard Pinel, 69500 Bron, France; Université Claude-Bernard Lyon-1, 43, boulevard du 11-Novembre-1918, 69622 Villeurbanne cedex, France.
Non-functioning pituitary adenomas frequently cause visual impairment and ocular motor disorders. Regular neuro-ophthalmologic assessments are crucial for timely diagnosis and guiding treatment decisions.
Area of Science:
- Neuro-ophthalmology
- Endocrinology
- Neurosurgery
Background:
- Non-functioning pituitary adenomas (NFAs) are a common cause of visual impairment, affecting 58% of patients.
- Patients often have delayed awareness of visual dysfunction due to compensatory vision.
- Ocular motor disorders, though rarer, can also occur.
Purpose of the Study:
- To review the neuro-ophthalmologic manifestations of NFAs.
- To highlight the diagnostic and prognostic value of various assessment methods.
- To emphasize the role of neuro-ophthalmologic findings in guiding NFA treatment.
Main Methods:
- Review of clinical presentations and diagnostic tools for NFA-related visual and ocular motor deficits.
- Discussion of neuro-ophthalmologic assessment techniques including visual acuity, visual field, fundus examination, and optical coherence tomography (OCT).
- Evaluation of diagnostic criteria for pituitary apoplexy and its impact on treatment decisions.
Main Results:
- Visual impairment is a primary consequence of NFAs, with significant impact on patient quality of life.
- Diplopia can occur with or without ocular motor deficits, including 'hemifield slide' and palsies (IIIrd, IVth, VIth nerve).
- Pituitary apoplexy frequently causes ocular motor (70%) and visual (75%) impairment, significantly influencing management.
Conclusions:
- Comprehensive neuro-ophthalmologic evaluation is essential for diagnosing and managing patients with NFAs.
- OCT provides reproducible quantification of optic atrophy and prognostic information for visual recovery.
- The extent of visual and ocular motor impairment is a key factor in determining treatment strategies for pituitary apoplexy.
