scholarly journals Reduced Visual Field Activity Due to Covid-19 in a Patient With a Pituitary Macroadenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A607-A607
Author(s):  
Matthew Norman Rosner ◽  
Ribal Al Aridi
Keyword(s):  
Visual Field ◽  
Visual Fields ◽  
Serum Prolactin ◽  
Pituitary Macroadenoma ◽  
Surgical Interventions ◽  
First Line Therapy ◽  
Vertebrobasilar System ◽  
Ophthalmic Manifestations ◽  
Field Defects ◽  
Transsphenoidal Resection

Abstract Background: Vision changes can be the presenting symptom of pituitary macroadenomas. The first-line therapy is transsphenoidal resection except for macroprolactinomas where medical therapy with dopamine agonist (DA) is the initial treatment of choice. Surgical resection is reserved if treatment with DA did not result in decreased serum prolactin (PRL), size of adenoma and/or alleviation of symptoms. With the Covid-19 pandemic, there have been a variety of symptoms reported including ophthalmic manifestations (1). We will present how an acute decrease in vision from Covid-19 nearly led to surgical intervention of macroprolactinoma. Clinical Case: A 61-year-old woman presented to the emergency room (ER) with complaints of headache in 6/2020. MRI Brain showed a 4.0 x 4.0 x 4.5 cm pituitary macroadenoma with suprasellar extension and invasion of the cavernous sinuses. The mass engulfed the adjacent circle of Willis, the MCAs bilaterally, the PCAs and the superior aspect of the vertebrobasilar system. Initial PRL was 7441 ng/mL (5.2-26.25 ng/mL). She was discharged on Cabergoline 0.25 mg twice weekly. Visual field exam showed mild nonspecific field defects in the right eye and larger diffuse field defects in the left eye slightly more temporal. One month later, Cabergoline dose was increased to 0.5 mg twice weekly with PRL drop to 1161.7 ng/mL. In 8/2020, she started to complain of worsening vision. Ophthalmological exam showed worsening visual fields in both eyes and the optic discs showed temporal pallor. She was referred to ER where she tested positive for Covid-19 and was admitted. CT Head showed stable partially calcified enhancing sellar and suprasellar mass. Repeat PRL was 635.6 ng/mL. Despite reduction in PRL, transsphenoidal resection was considered but was deferred to 9/2020 due to Covid-19. Follow up appointment with Neuro-ophthalmology in 9/2020 prior to scheduled surgery, showed visual field improvement with just mild nonspecific defects and surgery was canceled. PRL in 10/2020 decreased to 239.1 ng/mL. Patient’s visual fields continued to improve after recovery from Covid-19 and with reduction in PRL. It was determined that the patient’s reduction in visual fields was due to Covid-19 and not her macroadenoma. Conclusion: There have not been many reported cases of decreased visual fields due to Covid-19 (1). Proposed mechanisms include expression of ACE-2 receptors in the aqueous humor, which is the main receptor for Covid-19, and thromboembolic disease (1). More studies and data are needed to conclude the mechanism of decreased visual fields. This will avoid unnecessary surgical interventions for patients with macroprolactinomas. References: 1. Ho, D., Low, R., Tong, L., et al. COVID-19 and the Ocular Surface: A Review of Transmission and Manifestations. Ocul Immunol Inflamm. 2020 Jul 3;28(5):726-734.

scholarly journals Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

2007 ◽  
Vol 156 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Ilan Shimon ◽  
Carlos Benbassat ◽  
Moshe Hadani
Keyword(s):  
Visual Field ◽  
The Other ◽  
Serum Prolactin ◽  
Visual Field Defects ◽  
First Line ◽  
Giant Prolactinoma ◽  
First Line Therapy ◽  
Line Therapy ◽  
Giant Prolactinomas ◽  
Field Defects

Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24–52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393 ± 14 579 ng/ml (range 2047–55 033 ng/ml; normal 5–17 ng/ml). Following treatment, levels normalized in ten men within 1–84 months (mean, 25.3 months) and decreased in the other two to 2–3 times of normal. Tumor diameter, which measured 40–70 mm at diagnosis, showed a mean maximal decrease of 47 ± 21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.

Influence of Carteolol and Timolol on IOP and Visual Fields in Glaucoma: A Multi-Center, Double-Masked, Prospective Study

1992 ◽  
Vol 2 (4) ◽  
pp. 169-174 ◽  
Author(s):  
J. Flammer ◽  
Y. Kitazawa ◽  
L. Bonomi ◽  
B. Mills ◽  
M. Fsadni ◽  
...  
Keyword(s):  
Visual Field ◽  
Prospective Study ◽  
Beta Blockers ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Eye Drops ◽  
Treatment Groups ◽  
Visual Field Damage ◽  
One Year ◽  
Field Defects

The influences of Carteolol and Timolol eye drops on intraocular pressure (IOP) and visual fields were compared in a multi-center, double-masked, prospective study. Two-hundred and forty eyes of 120 patients were initially included in the study, and 142 eyes of 72 patients fulfilled all the criteria for final statistical analysis. Both drugs significantly reduced IOP. The visual fields in both treatment groups did not change during one year of treatment. In both groups some patients improved slightly, and others deteriorated slightly. This indicates that locally applied beta-blockers may efficiently stop further progression of visual field defects in cases with increased IOP and early visual field damage. There was no difference between Carteolol and Timolol in this regard. The side effects were minimal, and there were no differences in their frequency or intensity in the two treatment groups.

Reading with Visual Field Defects

Perception ◽  
1997 ◽  
Vol 26 (1_suppl) ◽  
pp. 11-11 ◽  
Author(s):  
S Trauzettel-Klosinski
Keyword(s):  
Eye Movements ◽  
Visual Field ◽  
Reading Ability ◽  
Reading Speed ◽  
Visual Fields ◽  
Zero Point ◽  
Normal Subjects ◽  
Visual Field Defects ◽  
Video Tape ◽  
Field Defects

The influence of different visual field defects on the reading performance was examined with potential adaptive strategies to improve the reading process in mind. By means of an SLO, the retinal fixation locus (RFL) was determined with the use of single targets and text, and eye movements scanning the text were recorded on video tape. Additionally, eye movements were monitored by an Infrared Limbus Tracker. Visual fields were assessed by the Tübingen Manual and/or automatic perimetry. Normal subjects, and patients with central scotomata, ring scotomata, and hemianopic field defects (HFD) were examined. The main pathological reading parameters were an increase of saccade frequency and regressions per line, and a decrease of reading speed. In patients with field defects involving the visual field centre, fixation behaviour is significant for regaining reading ability. In absolute central scotoma, the lost foveal function promotes eccentric fixation. The remaining problem is insufficient resolution of the RFL, which can be compensated for by magnification of the text. In patients with insufficient size of their reading visual field, due to HFD and ring scotoma, it is crucial that they learn to use a new RFL despite intact foveolar function. Preconditions for reading have been found to be: (1) sufficient resolution of the RFL, (2) a reading visual field of a minimum extent, and (3) intact basic oculomotor function. In patients with visual field defects involving the centre, a sensory-motor adaptation process is required: the use of a new RFL as the new centre of the visual field and as the new zero point for eye-movement coordinates.

Normal visual fields as assessed by computerized static threshold perimetry in patients with untreated primary hypothyroidism

1989 ◽  
Vol 121 (4) ◽  
pp. 495-500 ◽  
Author(s):  
Bengt Hallengren ◽  
Per Manhem ◽  
Margareta Bramnert ◽  
Inga Redlund-Johnell ◽  
Anders Heijl
Keyword(s):  
Visual Field ◽  
Prospective Study ◽  
Visual Fields ◽  
Primary Hypothyroidism ◽  
Common Finding ◽  
Visual Field Defects ◽  
Computer Assisted ◽  
Computerized Perimetry ◽  
Assisted Analysis ◽  
Field Defects

Abstract. In this prospective study, 25 consecutive patients with untreated primary hypothyroidism were tested with a highly sensitive perimetric technique, since a high prevalence of visual field defects has been described in this condition. All patients had clinical hypothyroidism, a serum TSH value > 20 mU/l (reference range 0.4–4.0) and decreased/low normal serum total T4 concentration. Visual fields were tested with fully automated threshold-measuring computerized perimetry of the central 30 degrees field. Interpretation of fields included computer-assisted analysis provided by a perimetric statistical programme package. In 23 patients, conventional inspection and computer-assisted analysis showed no visual field defects. Two patients were excluded from the latter analysis: one patient who did not respond adequately at computerized perimetry and in whom manual field tests were entirely normal; one patient who had low sensitivity values in the uppermost parts of both visual fields owing to markedly swollen upper eye lids. In conclusion, although pituitary hyperplasia has been well documented in primary hypothyroidism, the present prospective study clearly indicates that visual field defects are not a common finding in patients with this disease.

Retrogeniculate Visual Field Defects

Visual Fields ◽  
2010 ◽  
Author(s):  
Thomas R. Hedges III
Keyword(s):  
Visual Field ◽  
Vision Loss ◽  
Visual Fields ◽  
Field Testing ◽  
Visual Field Defects ◽  
Automated Perimetry ◽  
Loss Of Vision ◽  
Data Points ◽  
Field Defects ◽  
Macular Sparing

Automated perimetry has changed visual field testing considerably in recent years. What was considered an art has become an exercise in interpreting a set of data points obtained mechanically. Automated perimetry saves ophthalmologists time, which ideally should allow for more visual fields to be obtained on patients with unexplained vision loss. However, one must still keep in mind that automated perimetry still depends on the subjective responses from the patient. More important, automated perimetry has made interpretation of visual field defects, especially those due to occipital lesions, more difficult. For example, macular sparing may not be reflected, especially with programs limited to the central 24° or 30°. A 10° field may be required to show macular sparing. Also, sparing or involvement of the temporal crescent will not be shown with 24° or 30° visual fields. The limitation of most programs may lead to the appearance of incongruity when in fact the field is indeed congruous. Sometimes, a small homonymous hemianopic scotoma will be detected when one eye is tested but will be completely missed when the other eye is tested, giving the false impression that the visual loss is monocular. This is especially problematic if the patient also falsely interprets his or her homonymous loss of vision as monocular. Such individuals may complain of loss of vision in one eye when in fact it is one half of their visual field that is defective. The strategy of automated testing on either side the vertical and horizontal meridians may lead to the false impression that field defects respect the vertical or horizontal meridian when they do not. Automated perimetry should make it possible to test more patients with unexplained vision loss, but all automated visual fields must be interpreted with caution and, when necessary, substantiated with some other method, such as the tangent screen, which remains the most powerful method of detecting the size, shape, and density of visual field defects. Because most ophthalmologists no longer use tangent screen testing, at least an Amlser grid should be used to qualify the nature of a paracentral visual field defect.

Chiasmal Syndromes

2019 ◽  
pp. 61-66
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Visual Field ◽  
Clinical Features ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Surgical Decompression ◽  
Visual Field Defects ◽  
Pituitary Macroadenoma ◽  
Visual Recovery ◽  
Field Defects ◽  
Pituitary Macroadenomas

Dysfunction of the optic chiasm typically produces bitemporal hemianopic visual field defects. Optic chiasmal dysfunction most often results from compression by extrinsic lesions, such as pituitary macroadenomas and meningiomas. In this chapter, we begin by describing the various bitemporal hemianopic visual field defects that can occur with optic chiasmal dysfunction. We next list potential causes of optic chiasmal dysfunction. We then review the clinical features and evaluation of pituitary apoplexy, which results from infarction of (or hemorrhage into) a pituitary macroadenoma. Lastly, we discuss the management of pituitary apoplexy, including the indications for and timing of surgical decompression, and review factors that affect the prognosis for visual recovery.

scholarly journals From headache to Rathke’s cleft cyst followed by diabetes insipidus with panhypopituitarism

2015 ◽  
Vol 21 (3) ◽  
pp. 137-140
Author(s):  
Ana Valea ◽  
Alexandra Marcusan ◽  
Mara Carsote ◽  
Adina Ghemigian ◽  
Cristina Ghervan ◽  
...  
Keyword(s):  
Visual Field ◽  
Diabetes Insipidus ◽  
Serum Prolactin ◽  
Visual Field Defects ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Central Hypothyroidism ◽  
Iatrogenic Complications ◽  
Rathke's Cleft ◽  
Field Defects

ABSTRACT Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism. Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary. Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding

Reduced Size of a Hormonally Silent Pituitary Adenoma during Treatment with CV 205-502, a New Dopamine Agonist Mainly Stimulating D2 Receptors

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 948-950 ◽  
Author(s):  
Pavo Hedner ◽  
Stig Valdemarsson
Keyword(s):  
Visual Field ◽  
Tumor Size ◽  
Pituitary Tumor ◽  
Visual Fields ◽  
Immunohistochemical Analysis ◽  
Visual Field Defects ◽  
Tumor Mass ◽  
Computed Tomographic ◽  
Silent Pituitary Adenoma ◽  
Field Defects

Abstract A 39-year-old woman with secondary amenorrhea and visual field defects underwent craniotomy for a large pituitary tumor that was hormonally silent according to measurement of plasma hormone levels and immunohistochemical analysis. During the preoperative investigation, bromocriptine was administered for 1 month, but there was no change in the tumor size as seen on computed tomographic scans. One month after surgery, visual field defects recurred, and a tumor mass comparable to the preoperative state was found on computed tomographic scan. The tumor size gradually diminished during treatment with CV 205-502, a tricyclic benzoquinoline which stimulates mainly D2receptors and is better tolerated than bromocriptine. The visual fields were completely normalized after 3 months of treatment with the drug, and surgical management of the tumor mass was no longer considered to be necessary. Thus, as in many similar cases, the hormonally silent pituitary tumor in this patient proved unresponsive to bromocriptine treatment. In contrast. the tumor was reduced by therapy with CV 205-502, a drug that is better tolerated and might permit a more intense stimulation of D2receptors.

Sign in / Sign up

Export Citation Format

Share Document