Somatostatin analogue use to treat visual field loss in acromegaly newly diagnosed in pregnancy

2018 ◽  
Author(s):  
Hannon Anne Marie ◽  
Isolda Frizelle ◽  
Domhnall J O'Halloran
Keyword(s):  
Visual Field ◽  
Visual Field Loss ◽  
Somatostatin Analogue ◽  
Newly Diagnosed ◽  
In Pregnancy

scholarly journals Visual disturbance as primary symptom of pituitary apoplexy in pregnancy

2021 ◽  
Vol 3 (4) ◽  
pp. 244-249
Author(s):  
Norazlida Ibrahim ◽  
Raja Norliza Binti Raja Omar ◽  
Mae-Lynn Catherine Bastion
Keyword(s):  
Visual Field ◽  
Pituitary Apoplexy ◽  
Wide Spectrum ◽  
Brain Mri ◽  
Visual Field Loss ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Mortality And Morbidity ◽  
Pituitary Lesion ◽  
In Pregnancy

Pituitary apoplexy in pregnancy is a potentially fatal condition caused by acute ischaemic infarction or haemorrhage of pre-existing pituitary adenoma or within a physiologically enlarged pituitary gland. It has a wide spectrum of clinical presentations ranging from a mild headache to sudden collapsed. Here, we report a life-threatening case of pituitary apoplexy in a non-functioning pituitary macroadenoma occurring during pregnancy that presented with bilateral blurring of vision. Visual field showed bitemporal superior quadrantanopia. Urgent non-contrast brain MRI revealed an acute expansion of a hemorrhagic pituitary lesion complicated with local compression to the optic chiasm. The patient underwent an uneventful right supraorbital craniotomy and excision of the tumour under general anaesthesia with no foetal loss. The repeated visual field at 2 weeks after surgery showed recovering visual field defect. Hence, early neurosurgical intervention is advisable to prevent mortality and morbidity due to permanent visual field loss.

scholarly journals Octreotide use for rescue of vision in a pregnant patient with acromegaly

2019 ◽  
Vol 2019 ◽  
Author(s):  
Anne Marie Hannon ◽  
Isolda Frizelle ◽  
George Kaar ◽  
Steven J Hunter ◽  
Mark Sherlock ◽  
...  
Keyword(s):  
Post Partum ◽  
Treatment Options ◽  
Elective Caesarean Section ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Pregnant Patient ◽  
Somatostatin Analogue ◽  
Insulin Regimen ◽  
List Type ◽  
In Pregnancy

Summary Pregnancy in acromegaly is rare and generally safe, but tumour expansion may occur. Managing tumour expansion during pregnancy is complex, due to the potential complications of surgery and side effects of anti-tumoural medication. A 32-year-old woman was diagnosed with acromegaly at 11-week gestation. She had a large macroadenoma invading the suprasellar cistern. She developed bitemporal hemianopia at 20-week gestation. She declined surgery and was commenced on 100 µg subcutaneous octreotide tds, with normalisation of her visual fields after 2 weeks of therapy. She had a further deterioration in her visual fields at 24-week gestation, which responded to an increase in subcutaneous octreotide to 150 µg tds. Her vision remained stable for the remainder of the pregnancy. She was diagnosed with gestational diabetes at 14/40 and was commenced on basal bolus insulin regimen at 22/40 gestation. She otherwise had no obstetric complications. Foetal growth continued along the 50th centile throughout pregnancy. She underwent an elective caesarean section at 34/40, foetal weight was 3.2 kg at birth with an APGAR score of 9. The neonate was examined by an experienced neonatologist and there were no congenital abnormalities identified. She opted not to breastfeed and she is menstruating regularly post-partum. She was commenced on octreotide LAR 40 mg and referred for surgery. At last follow-up, 2 years post-partum, the infant has been developing normally. In conclusion, our case describes a first presentation of acromegaly in pregnancy and rescue of visual field loss with somatostatin analogue therapy. Learning points: Tumour expansion may occur in acromegaly during pregnancy. Treatment options for tumour expansion in pregnancy include both medical and surgical options. Somatostatin analogues may be a viable medical alternative to surgery in patients with tumour expansion during pregnancy.

scholarly journals What do patients with glaucoma see: a novel iPad app to improve glaucoma patient awareness of visual field loss

2020 ◽  
pp. bjophthalmol-2020-317034
Author(s):  
Meghal Gagrani ◽  
Jideofor Ndulue ◽  
David Anderson ◽  
Sachin Kedar ◽  
Vikas Gulati ◽  
...  
Keyword(s):  
Visual Field ◽  
Vision Loss ◽  
Peripheral Vision ◽  
Glaucoma Patient ◽  
Visual Field Loss ◽  
Sensitivity Threshold ◽  
Roc Curve Analysis ◽  
The Mean ◽  
Ipad App ◽  
Field Defects

PurposeGlaucoma patients with peripheral vision loss have in the past subjectively described their field loss as ‘blurred’ or ‘no vision compromise’. We developed an iPad app for patients to self-characterise perception within areas of glaucomatous visual field loss.MethodsTwelve glaucoma patients with visual acuity ≥20/40 in each eye, stable and reliable Humphrey Visual Field (HVF) over 2 years were enrolled. An iPad app (held at 33 cm) allowed subjects to modify ‘blur’ or ‘dimness’ to match their perception of a 2×2 m wall-mounted poster at 1 m distance. Subjects fixated at the centre of the poster (spanning 45° of field from centre). The output was degree of blur/dim: normal, mild and severe noted on the iPad image at the 54 retinal loci tested by the HVF 24-2 and was compared to threshold sensitivity values at these loci. Monocular (Right eye (OD), left eye (OS)) HVF responses were used to calculate an integrated binocular (OU) visual field index (VFI). All three data sets were analysed separately.Results36 HVF and iPad responses from 12 subjects (mean age 71±8.2y) were analysed. The mean VFI was 77% OD, 76% OS, 83% OU. The most common iPad response reported was normal followed by blur. No subject reported dim response. The mean HVF sensitivity threshold was significantly associated with the iPad response at the corresponding retinal loci (For OD, OS and OU, respectively (dB): normal: 23, 25, 27; mild blur: 18, 16, 22; severe blur: 9, 9, 11). On receiver operative characteristic (ROC) curve analysis, the HVF retinal sensitivity cut-off at which subjects reported blur was 23.4 OD, 23 OS and 23.3 OU (dB).ConclusionsGlaucoma subjects self-pictorialised their field defects as blur; never dim or black. Our innovation allows translation of HVF data to quantitatively characterise visual perception in patients with glaucomatous field defects.

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