The effect of previous optic chiasm compression on the post-illumination pupil response in pituitary patients

2019 ◽  
Author(s):  
Tessel Boertien ◽  
Wisse van der Meijden ◽  
Adriaan Coumou ◽  
Madeleine Drent ◽  
Eus Van Someren ◽  
...  
Keyword(s):  
2019 ◽  
Vol 70 (5) ◽  
pp. 1603-1607
Author(s):  
Elena Ionescu ◽  
Bogdan Virgil Cotoi ◽  
Anca Ganescu

Pituitary is a common terrain for the appearance of tumoral changes, representing the origin of about 15% of all intracranial tumors [13]. These tumors are, for the most part, histologically benign, as they arise from hormone secreting cells in the anterior lobe. Therefore, the aim of the paper is to specify the clinical and paraclinical clinical onset characteristics, the evolutionary peculiarities, as well as the metabolic complications secondary to the prolactin hypersecretion. The effects of prolactin-secreting pituitary tumors may occur as a result of mass effects of tumors or even hyperprolactinaemia. Because microadenomas are intrathecal, visual defects may not occur, but headaches occur more often (50%) than normal (27%) [1, 6]. A large tumor that extends beyond the limbs of the turkey can cause headaches and vision defects. The classical presentation is bitemporal hemianopsia due to the compression of the optic chiasm from a tumor that extends to the upper level. If chiasma is prefixed or if the tumor extends posteriorly, compression of a single optical system results in visual field defects similar. The lateral extension in the cavernous sinus can lead to the illness of the oculomotor function involving the cranial nerves III, IV and VI and the branches V1 and V2 of the cranial nerve V, alone or in combinations.


2015 ◽  
Vol 22 (2) ◽  
pp. 169-177 ◽  
Author(s):  
Iulia Potorac ◽  
Patrick Petrossians ◽  
Adrian F Daly ◽  
Franck Schillo ◽  
Claude Ben Slama ◽  
...  

Responses of GH-secreting adenomas to multimodal management of acromegaly vary widely between patients. Understanding the behavioral patterns of GH-secreting adenomas by identifying factors predictive of their evolution is a research priority. The aim of this study was to clarify the relationship between the T2-weighted adenoma signal on diagnostic magnetic resonance imaging (MRI) in acromegaly and clinical and biological features at diagnosis. An international, multicenter, retrospective analysis was performed using a large population of 297 acromegalic patients recently diagnosed with available diagnostic MRI evaluations. The study was conducted at ten endocrine tertiary referral centers. Clinical and biochemical characteristics, and MRI signal findings were evaluated. T2-hypointense adenomas represented 52.9% of the series, were smaller than their T2-hyperintense and isointense counterparts (P<0.0001), were associated with higher IGF1 levels (P=0.0001), invaded the cavernous sinus less frequently (P=0.0002), and rarely caused optic chiasm compression (P<0.0001). Acromegalic men tended to be younger at diagnosis than women (P=0.067) and presented higher IGF1 values (P=0.01). Although in total, adenomas had a predominantly inferior extension in 45.8% of cases, in men this was more frequent (P<0.0001), whereas in women optic chiasm compression of macroadenomas occurred more often (P=0.0067). Most adenomas (45.1%) measured between 11 and 20 mm in maximal diameter and bigger adenomas were diagnosed at younger ages (P=0.0001). The T2-weighted signal differentiates GH-secreting adenomas into subgroups with particular behaviors. This raises the question of whether the T2-weighted signal could represent a factor in the classification of acromegalic patients in future studies.


Author(s):  
Gamze Akkus ◽  
Barış Karagun ◽  
Hilal Nur Yaldız ◽  
Mehtap Evran ◽  
Murat Sert ◽  
...  

AbstractObjectivesProlactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.MethodsThe present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.ResultsMacroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.ConclusionsAlthough a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.


2018 ◽  
Vol 1124 ◽  
pp. 031016 ◽  
Author(s):  
D Bobrova ◽  
N Bikberdina ◽  
M Boronenko

2017 ◽  
Vol 78 (04) ◽  
pp. 407-411 ◽  
Author(s):  
Ryosuke Tashiro ◽  
Teiji Tominaga ◽  
Yoshikazu Ogawa

AbstractReactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation.We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course.Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.


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