Pituitary Macroadenoma: Fooling the Ophthalmologist before Giving Him the Role of the Whistle-Blower

To describe cases diagnosed with pituitary macroadenoma during the follow-up of their primary ocular pathologies.

Charts of patients followed in the Centre for Ophthalmic Specialized Care for diverse pathologies and who had subsequently developed a pituitary macroadenoma were retrieved. The primary pathologies were noted. The delay of the diagnosis after sufficiently compatible perimetric signs became available was calculated and the evolution after the neurosurgical intervention was reported.

In total, from 2003 to 2020, 16/14 966 (0.1%) pituitary macroadenoma patients were recorded. In 10 patients, the disease was noted in their history. In 6 patients (2 females, 4 males; 0.04%), macroadenoma occurred during the follow-up for their primary ocular pathologies. Mean age at first presentation was 65.16 ± 8.52 years. Primary pathologies included amblyopia (1), glaucoma (2), cataract (4), and uveitis (2). Mean duration of symptoms was 18.17 ± 13.11 months. Mean delay from first suspicious visual field signs to diagnosis was 125 ± 207.93 days. All patients underwent one surgical treatment with or without radiotherapy except one where a second intervention was required. All patients have seen their visual field improve after surgical intervention. Mean preoperative Mean defect (MD) was 13.43 ± 8.68 dB OD and 13.4 ± 5.07 dB OS. Mean postoperative MD was 8.2 ± 10.27 dB OD and 5.42 ± 4.12 dB OS.

Pituitary macroadenomas are prone to be missed or diagnosed with delay when ophthalmic patients are already followed for another pathology that prevents the clinician from diligently evoking the diagnosis. Despite profound visual field loss, visual recovery was almost complete in 4/6 patients, indicating that even diagnostic delay did not preclude recovery in our series.