Pituitary metastasis in breast cancer: case report and literature review

2020 ◽  
Author(s):  
Xiaosong Sha ◽  
Xiejun Zhang ◽  
Lei Chen ◽  
Jihu Yang ◽  
Guodong Huang
Keyword(s):  
Breast Cancer ◽  
Visual Field ◽  
Diabetes Insipidus ◽  
Diagnostic Methods ◽  
Electrolyte Imbalance ◽  
Visual Field Defects ◽  
Nerve Paralysis ◽  
Loss Of Vision ◽  
Field Defects ◽  
Pituitary Metastasis

Abstract Background: Breast cancer commonly metastasizes to the lung, vertebrae or liver but rarely to the pituitary gland. The majority of cases have been reported during autopsy; however, with the improvements in diagnostic methods, there has been an increasing number of cases reported in the clinical setting. The main symptoms of pituitary metastasis are reported to be headache, diabetes insipidus and visual field defects, which may cause confusion regarding the clinical diagnosis.Case presentation: The present study describes a case of pituitary metastasis symptoms of diabetes insipidus and loss of vision in a patient with breast cancer. After the patient completed the evaluation, a neuroendoscopy-assisted endonasal transsphenoidal tumor resection was performed. The postoperative biopsy revealed metastatic breast cancer.Conclusions: The present study analyzed this patient and 16 other cases of pituitary metastases collected from the PubMed database. Lung cancer, breast cancer and lymphoma could metastasize to the sellar region, while certain other tumors from the liver, parotid, colon, prostate, stomach, kidney, thyroid or skin were also observed. The clinical manifestation was often dominated by pituitary dysfunction, intracranial hypertension and visual field defects. Certain patients may suffer from oculomotor nerve paralysis, electrolyte imbalance, diabetes insipidus or a loss of vision. Imaging findings revealed that sellar metastases often invaded the suprasellar region. In a few cases, the lesion enclosed intracranial vessels, and invaded the cavernous sinus or Meckel's cave. These characteristics resulted in difficulties during surgery.

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.

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

Visual Recovery after Transsphenoidal Removal of Pituitary Adenomas

Neurosurgery ◽  
1985 ◽  
Vol 17 (3) ◽  
pp. 446-452 ◽  
Author(s):  
Alan R. Cohen ◽  
Paul R. Cooper ◽  
Mark J. Kupersmith ◽  
Eugene S. Flamm ◽  
Joseph Ransohoff
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Diabetes Insipidus ◽  
Pituitary Adenomas ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Duration Of Symptoms ◽  
Patients Âgés ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Field Defects

Abstract We reviewed the records of 100 consecutive patients with histologically verified pituitary adenomas who underwent transsphenoidal decompression of the optic nerves and chiasm. The patients' ages ranged from 18 to 80 years, with a median of 52 years. Preoperatively, all patients had objective signs of visual acuity or field defects. Postoperatively, visual acuity was normal or improved in 79% of the eyes and the visual fields were normal or improved in 74%. The visual outcome (for both acuity and fields) was better in younger patients and those with a shorter duration of symptoms. Patients with lesser degrees of preoperative visual acuity compromise had better postoperative visual acuity outcome. However, the severity of preoperative visual field defects did not seem to predict postoperative field outcome, and even patients with severe preoperative field defects often had striking postoperative improvement. Patients who had undergone prior operation were less likely to have either visual acuity or visual field improvement after reoperation. Postoperative deterioration in visual acuity was noted in only 5 patients (6 eyes). Complications were few. There were 4 instances of cerebrospinal fluid rhinorrhea, but only 2 patients needed operative repair. There was no instance of permanent diabetes insipidus, although 17 patients developed transient diabetes insipidus. In most cases, visual improvement was sustained. The average duration of follow-up was 26 months. Three patients required a subsequent operation to correct visual loss in the immediate postoperative period, but only 1 patient has undergone late operation for recurrence of tumor. There was no operative mortality.

scholarly journals Central Visual Field Defects in Patients with Distinct Glaucomatous Optic Disc Phenotypes

2021 ◽  
Vol 223 ◽  
pp. 229-240
Author(s):  
Eren Ekici ◽  
Sasan Moghimi ◽  
Huiyuan Hou ◽  
James Proudfoot ◽  
Linda M. Zangwill ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Disc ◽  
Visual Field Defects ◽  
Central Visual Field ◽  
Field Defects

Computerized color perimetry in multiple sclerosis

1998 ◽  
Vol 4 (2) ◽  
pp. 79-84 ◽  
Author(s):  
N Accornero ◽  
S Rinalduzzi ◽  
M Capozza ◽  
E Millefiorini ◽  
G C Filligoi ◽  
...  
Keyword(s):  
Visual Field ◽  
Statistical Difference ◽  
Cost Effective ◽  
Quantitative Information ◽  
Field Analysis ◽  
Visual Field Defects ◽  
Highly Sensitive ◽  
The Subject ◽  
Color Perimetry ◽  
Field Defects

Color visual field analysis has proven highly sensitive for early visual impairments diagnosis in MS, yet it has never attained widespread popularity usually because the procedure is difficult to standardize, the devices are costly, and the test is fatiguing. We propose a computerized procedure running on standard PC, cost effective, clonable, and easy handled. Two hundred and sixty-four colored patches subtending 18 angle of vision, with selected hues and low saturation levels are sequentially and randomly displayed on gray equiluminous background of the PC screen subtending 2486408 angle of vision. The subject is requested to press a switch at the perception of the stimulus. The output provides colored maps with quantitative information. Comparison between normals and a selected population of MS patients with no actual luminance visual field defects, showed high statistical difference.

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