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Updated: Jul 12, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Neuroretinal damage associated with pituitary macroadenoma: endocrine and radiological predictors and correlation
Diego Fernandez-Velasco1,2, Elena Garcia-Martin1,2, Belen Santamaria3
1Hospital Universitario Miguel Servet, Servicio de Oftalmologia, Zaragoza, Spain.
Objective:
To identify endocrine and radiological tumor characteristics associated with higher risk of visual impairment.
Methods:
A retrospective observational study included 40 patients with pituitary macroadenoma. Variables analyzed were age, sex, disease duration, treatment, hormonal profile, tumor volume, and ophthalmic parameters: visual acuity (VA), perimetry, and retinal analysis using optical coherence tomography (OCT).
Results:
Surgery normalized ACTH, cortisol, IGF-1, and prolactin levels. Larger tumor volumes were observed in males, nonfunctioning tumors, nonoperated patients, and relapses. Larger tumors were associated with worse visual field, while VA remained stable. OCT showed thinning of total retina and inner retinal layers in patients with disease duration >5 years, nonfunctioning tumors, larger tumors, postoperative status, and relapse (p < 0.05). Macular ganglion cell layer thickness correlated inversely with IGF-1 and prolactin, and retinal nerve fiber layer with tumor size. The inner nuclear layer exhibited a non-linear behavior, thickening in early stages while thinning in severe injury.
Conclusion:
Hormonal and radiological factors are associated with visual dysfunction. OCT and perimetry detect early visual pathway damage better than VA. Non-linear behavior of the INL stand out as a potential prognostic biomarker.
