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Zhang Y, Zheng J, Huang Z, Teng Y, Chen C, Xu J. Predicting visual recovery in pituitary adenoma patients post-endoscopic endonasal transsphenoidal surgery: Harnessing delta-radiomics of the optic chiasm from MRI. Eur Radiol 2023; 33:7482-7493. [PMID: 37488296 PMCID: PMC10598191 DOI: 10.1007/s00330-023-09963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To investigate whether morphological changes after surgery and delta-radiomics of the optic chiasm obtained from routine MRI could help predict postoperative visual recovery of pituitary adenoma patients. METHODS A total of 130 pituitary adenoma patients were retrospectively enrolled and divided into the recovery group (n = 87) and non-recovery group (n = 43) according to visual outcome 1 year after endoscopic endonasal transsphenoidal surgery. Morphological parameters of the optic chiasm were measured preoperatively and postoperatively, including chiasmal thickness, deformed angle, and suprasellar extension. Delta-radiomics of the optic chiasm were calculated based on features extracted from preoperative and postoperative coronal T2-weighted images, followed by machine learning modeling using least absolute shrinkage and selection operator wrapped with support vector machine through fivefold cross-validation in the development set. The delta-radiomic model was independently evaluated in the test set, and compared with the combined model that incorporated delta-radiomics, significant clinical and morphological parameters. RESULTS Postoperative morphological changes of the optic chiasm could not significantly be used as predictors for the visual outcome. In contrast, the delta-radiomics model represented good performances in predicting visual recovery, with an AUC of 0.821 in the development set and 0.811 in the independent test set. Moreover, the combined model that incorporated age and delta-radiomics features of the optic chiasm achieved the highest AUC of 0.841 and 0.840 in the development set and independent test set, respectively. CONCLUSIONS Our proposed machine learning models based on delta-radiomics of the optic chiasm can be used to predict postoperative visual recovery of pituitary adenoma patients. CLINICAL RELEVANCE STATEMENT Our delta-radiomics-based models from MRI enable accurate visual recovery predictions in pituitary adenoma patients who underwent endoscopic endonasal transsphenoidal surgery, facilitating better clinical decision-making and ultimately improving patient outcomes. KEY POINTS • Prediction of the postoperative visual outcome for pituitary adenoma patients is important but challenging. • Delta-radiomics of the optic chiasm after surgical decompression represented better prognostic performances compared with its morphological changes. • The proposed machine learning models can serve as novel approaches to predict visual recovery for pituitary adenoma patients in clinical practice.
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Affiliation(s)
- Yang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Junkai Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Zhouyang Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Yuen Teng
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
- Department of Radiology, West China Hospital, Sichuan University, No. 37, GuoXue Alley, Chengdu, 610041, China.
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Demir AN, Sulu C, Kara Z, Sahin S, Ozaydin D, Sonmez O, Keskin FE, Tanriover N, Gazioglu N, Kadioglu P. Changing presentation of acromegaly in half a century: a single-center experience. Pituitary 2023; 26:573-582. [PMID: 37523026 DOI: 10.1007/s11102-023-01344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Investigate the changes in the characteristics of presentation, in patients with acromegaly over a period of approximately half a century. METHODS The medical records of patients diagnosed with acromegaly between 1980 and 2023 were retrospectively reviewed. The collected data were examined to assess any changes observed over the years and a comparison was made between the characteristics of patients diagnosed in the last decade and those diagnosed in previous years. RESULTS A total of 570 patients were included in the study, 210 (37%) patients were diagnosed in the last decade. Patients diagnosed before 2014 had longer symptom duration before diagnosis, advanced age, larger pituitary adenomas, higher incidence of cavernous sinus invasion, and higher GH and IGF-1 levels than those diagnosed last decade (p < 0.05, for all). Furthermore, the patients diagnosed before 2014 had a lower rate of surgical remission (p < 0.001), and a higher prevalence of comorbidities such as diabetes, hypertension, colon polyps, and thyroid cancer at the time of diagnosis (p < 0.05, for all). CONCLUSION There may be a trend for earlier detection of patients with acromegaly.
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Affiliation(s)
- Ahmet Numan Demir
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Cem Sulu
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Zehra Kara
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Serdar Sahin
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye
| | - Dilan Ozaydin
- Department of Neurosurgery, Health Sciences University, Kartal Doktor Lütfi Kırdar City Hospital, Istanbul, Türkiye
| | - Ozge Sonmez
- Department of Internal Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Fatma Ela Keskin
- Department of Endocrinology, Metabolism, and Diabetes, Demiroglu Bilim University, Istanbul, Türkiye
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Nurperi Gazioglu
- Department of Neurosurgery, Istinye University, Istanbul, Türkiye
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Pinar Kadioglu
- Department of Endocrinology, Metabolism, and Diabetes, Istanbul University-Cerrahpasa, 34098, Istanbul, Türkiye.
- Pituitary Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
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Lee G, Park K, Lee D, Oh SY, Kong D, Hong SD. Predicting visual outcomes after decompression of pituitary tumours based on stratified inner‐retinal layer thickness and age. Acta Ophthalmol 2022; 101:301-309. [PMID: 36398459 DOI: 10.1111/aos.15281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/05/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the potential role of stratified preoperative optical coherence tomography (OCT) measurements and age in predicting postoperative visual field (VF) improvement among adult patients with chiasmal compression due to pituitary tumours after decompression surgery. METHODS Postoperative visual outcomes were analysed using mean deviation of the VF test. Eyes were divided into three groups based on preoperative OCT parameters including peripapillary retinal nerve fibre layer (pRNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness: groups 1, 2 and 3 with pRNFL thickness <65 μm, 65 μm or more but <85 μm, and 85 μm or more, respectively. The GCIPL thickness was also divided into three groups based on values ranging from 55 to 77 μm. Each group was further categorized according to age: 20 years or older but younger than 40 years, 40 years or older but younger than 60, and 60 years or older. RESULTS This study included 197 eyes of 197 patients with chiasmal compression due to pituitary tumours. No patient showed complete VF recovery in group 1 with a preoperative pRNFL thickness <65 μm or a GCIPL thickness <55 μm regardless of age. These groups showed the worst VF outcome (pRNFL, p = 0.0001; GCIPL, p < 0.0001). However, a significant recovery in VF (greater than 2 dB) was observed in 45% of group 1 patients based on pRNFL thickness and in 61.54% of group 1 patients according to GCIPL thickness. In groups 2 and 3 with a preoperative pRNFL thickness of 65 μm or more and a GCIPL thickness of 55 μm or more, the rate of complete VF recovery decreased as subjects' ages increased. Group 3 with a preoperative pRNFL thickness of 85 μm or more and a GCIPL thickness of 77 μm or more were 2.5-fold and 4.0-fold more likely to completely recover VF, respectively, compared with group 2. CONCLUSIONS Stratified preoperative pRNFL and GCIPL thicknesses measured via OCT in different age categories are effective biomarkers for predicting visual functional outcomes.
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Affiliation(s)
- Ga‐In Lee
- Hangil Eye Hospital Incheon Republic of Korea
| | - Kyung‐Ah Park
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Doo‐Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology‐Head and Neck Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul South Korea
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Corneal Tonometric and Morphological Changes in Patients with Acromegaly. J Clin Med 2022; 11:jcm11226750. [PMID: 36431227 PMCID: PMC9696636 DOI: 10.3390/jcm11226750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Purpose: This study aimed to investigate the changes in Reichert Ocular Response Analyzer (ORA) parameters, corneal endothelium parameters, central corneal thickness (CCT), and intraocular pressure (IOP) before and after the transsphenoidal resection of pituitary adenoma in patients with acromegaly. (2) Methods: This was a single-center, prospective, interventional study. Twenty patients with newly diagnosed acromegaly were examined before and 19 ± 9 months after transsphenoidal resection. The participants underwent a comprehensive ophthalmological examination including pneumatic IOP (IOP air puff), Goldmann applanation tonometry (IOP GAT), CCT measured using the iPac pachymeter (CCTUP), IOP value corrected for CCTUP using the Ehlers formula (IOPc) ORA measurements included corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated IOP (IOPcc), and Goldmann-correlated IOP (IOPg). CCT from non-contact specular microscopy (CCTNSM), the number of endothelial cells (CD) per mm2, and average cell size (AVG) were determined with non-contact specular microscopy. (3) Results: A statistically significant decrease was observed in CCTUP (p = 0.007), and IOP air puff (p = 0.012) after surgery. Moreover, we noted a statistically significant increase in CD (p = 0.001), and a statistically significant decrease in AVG (p = 0.009) and CCTNSM (p = 0.004) after surgery. A statistically significant decrease was also observed in IOPg (p = 0.011), CH (p = 0.016), and CRF (p = 0.001) after surgery. The mean value of IOP GAT and IOPc was lower after the surgery. However, the difference was not statistically significant. (4) Conclusions: Our study revealed significant changes in biomechanics, corneal endothelium, CCT and IOP after pituitary adenoma resection in patients with acromegaly. It proves that the eye might be sensitive to long-term overexposure to growth hormone (GH) and insulin-like growth factor-1 (IGF-1). We suggest that disease activity be taken into consideration on ophthalmological examination.
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Lee GI, Kim J, Lee D, Park KA, Oh SY, Kong DS, Hong SD. Ganglion cell inner plexiform layer thickness measured by optical coherence tomography to predict visual outcome in chiasmal compression. Sci Rep 2022; 12:14826. [PMID: 36050400 PMCID: PMC9437084 DOI: 10.1038/s41598-022-17193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
We evaluated the prognostic value of the preoperative macular ganglion cell inner plexiform layer (mGCIPL) thickness along with peripapillary retinal nerve fiber layer (pRNFL) thickness measured by optical coherence tomography (OCT) and estimated an optimal cut-off value to predict postoperative visual field (VF) recovery in adult patients with chiasmal compression after decompression surgery. Two hundred forty eyes of 240 patients aged 20 years or older for which preoperative high-definition Cirrus OCT parameters and pre- and postoperative visual function data were available. The prognostic power of pRNFL and mGCIPL thicknesses for complete postoperative VF recovery or significant VF improvement (improvement ≥ 2 dB in the mean deviation) were assessed. The cut-off values for OCT parameters for VF recovery were estimated. The study found that the higher the preoperative pRNFL and mGCIPL thicknesses, the higher the probability of complete postoperative VF recovery (p = 0.0378 and p = 0.0051, respectively) or significant VF improvement (p = 0.0436 and p = 0.0177, respectively). The area under the receiver operating characteristic analysis of preoperative OCT parameters demonstrated that the mGCIPL thickness showed an area under the curve (AUC) of more than 0.7 for complete VF recovery after decompression surgery (AUC = 0.725, 95% CI: 0.655, 0.795), and the optimal mGCIPL thickness cut-off value for complete VF recovery was 77.25 µm (sensitivity 69% and specificity 69%). Preoperative mGCIPL thickness was a powerful predictor of visual functional outcome after decompression surgery for chiasmal compression.
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Affiliation(s)
| | - Joonhyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Doo-Sik Kong
- Department of Neurosurgery, Endoscopic Skull Base Surgery Clinic, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Meyer J, Diouf I, King J, Drummond K, Stylli S, Kaye A, Kalincik T, Danesh-Meyer H, Symons RCA. A comparison of macular ganglion cell and retinal nerve fibre layer optical coherence tomographic parameters as predictors of visual outcomes of surgery for pituitary tumours. Pituitary 2022; 25:563-572. [PMID: 35552990 DOI: 10.1007/s11102-022-01228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The prognostic value of optical coherence tomography (OCT) of the macular ganglion cell layer (mGGL) versus peripapillary retinal nerve fibre layers (pRNFL) following chiasmal decompression is unclear. This study is the largest comparison of the two parameters to date and aims to clarify how their performance as covariates compare in predictive models of long-term visual outcomes following pituitary or parasellar tumour surgical resection. METHODS This was a prospective, two-year, longitudinal cohort study in a single centre tertiary hospital setting. Participants with MRI evidence of pituitary or parasellar tumour compression of the optic chiasm who underwent surgical decompression, were enrolled. Associations between pre-operative OCT parameters and long-term visual outcomes were assessed using multivariable generalised linear mixed models and an age matched normative database. RESULTS Final analysis included 216 eyes of 108 participants with a mean age (standard deviation) of 51.6 (17.04) years, of whom 58 (49%) were female. The superior inner mGCL was the best predictor of long-term visual field recovery, with an area under the curve of 0.90, a sensitivity of 80%, specificity of 88%, positive predictive value of 86%, and negative predictive value of 83%. CONCLUSION mGCL performed better in predicting long-term visual field recovery post-pituitary or parasellar surgical resection. The superior inner mGCL was the best specific measure which may provide clinical utility in pre-operative counselling. In this study we clarify previously variable comparisons of mGCL and pRNFL parameters in post-operative predictive modelling.
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Affiliation(s)
- Joos Meyer
- Ophthalmology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.
| | - Ibrahima Diouf
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - James King
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Kate Drummond
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Stan Stylli
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Andrew Kaye
- Neurosurgery Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
- Department of Neurosurgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, MS Centre, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
| | - Helen Danesh-Meyer
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - R C Andrew Symons
- Ophthalmology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
- Centre For Eye Research Australia, Level 7/32 Gisborne St, East Melbourne, VIC, 3002, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Monash Medical Centre Level 5, Monash University, Block E 246 Clayton Road, Clayton, 3168, Australia
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Jeon H, Suh HB, Kim TY, Choi HY. Predictive value of OCT and MRI for postoperative visual recovery in patients with chiasmal compressive lesions. Eur J Ophthalmol 2022; 32:2982-2987. [PMID: 35001716 DOI: 10.1177/11206721211073216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to investigate the predictive value of retinal thickness measured by optical coherence tomography (OCT) and mass biometrics measured using magnetic resonance image (MRI) for visual recovery after surgery for removal of a mass compressing the optic chiasm. METHODS Consecutive patients who showed typical temporal visual field defect (VFD) with respect to the vertical meridian due to a chiasmal compressive mass and who underwent mass removal surgery were recruited. Ophthalmic examination was performed preoperatively and postoperatively. Retinal thickness was measured by the Cirrus OCT. The height and size of the mass and suprasellar extension (SSE) in both the sagittal and coronal planes were evaluated. Patients were divided into two groups based on the improvement in VFD (mean deviation [MD] change ≥ 5 dB: group R; others: group NR) and clinical characteristics were compared. RESULTS Fifteen patients were included in the study. Eight (53.3%) patients were allocated into group R and others (7 patients, 46.7%) into group NR. Age, sex, initial visual acuity, initial MD was not different between the two groups. The retinal thicknesses were not different while tumor height, volume, and both sagittal and coronal SSE were significantly different between the two groups. (p = 0.029, 0.014, <0.001, and <0.001, respectively) All MRI parameters showed significant predictive value for the degree of MD recovery. CONCLUSION MRI showed better predictive value than OCT in predicting postoperative VFD recovery in patients with temporal VFDs due to chiasmal compressive disorder.
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Affiliation(s)
- Hyeshin Jeon
- Department of Ophthalmology, 220312School of Medicine, Pusan National University Hospital, South Korea.,Biomedical Research Institute, 220312Pusan National University Hospital, Busan, South Korea
| | - Hie Bum Suh
- Biomedical Research Institute, 220312Pusan National University Hospital, Busan, South Korea.,Department of Radiology, 220312Pusan National University Hospital, Busan, South Korea
| | - Tae Yeon Kim
- Department of Ophthalmology, 220312School of Medicine, Pusan National University Hospital, South Korea
| | - Hee-Young Choi
- Department of Ophthalmology, 220312School of Medicine, Pusan National University Hospital, South Korea.,Biomedical Research Institute, 220312Pusan National University Hospital, Busan, South Korea
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Suh H, Choi H, Jeon H. The Radiologic Characteristics and Retinal Thickness Are Correlated With Visual Field Defect in Patients With a Pituitary Mass. J Neuroophthalmol 2021; 41:e541-e547. [PMID: 34788245 DOI: 10.1097/wno.0000000000001011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Investigation of visual field defects (VFDs) is important to decide the treatment and to predict the prognosis in patients with a pituitary mass. The aim of this study was to evaluate the correlation among 2 diagnostic modalities-MRI and optical coherence tomography (OCT)-and VFDs. METHODS Consecutive patients who showed the presence of a pituitary mass on MRI and in whom ophthalmic examinations were performed were recruited. Height and volume of the mass, sagittal and coronal displacement of optic chiasm, and the direction of mass expansion were measured. Patients were divided into 2 groups according to the presence (VFD group) or absence of VFDs (no VFDs group [NVFD]). The correlation among MRI parameters, OCT parameters, and VFDs were examined, and the diagnostic values of MRI and OCT and the combined value of the 2 modalities were analyzed. RESULTS Forty-one patients were included. The greatest coefficients of determination were observed between the sagittal displacement and pattern standard deviation (PSD) (R2 = 0.3661, P < 0.001) and between the inferonasal ganglion cell-inner plexiform layer (GCIPL) and PSD (R2 = 0.4079, P < 0.001). The height and the size of the mass in the VFD group were significantly greater as 57% and 148%, respectively, and the VFD group had more severe chiasmal displacement both in the sagittal (165%) and in the coronal (178%) plane (large effect in all). All macular GCIPLs were thinner in the NVFD group (range 9%-26%, large effect), whereas only temporal (25%) and average (11%) values were among peripapillary retinal nerve fiber layers. CONCLUSIONS The highest correlations with the degree of the VFD were seen in the sagittal displacement of optic chiasm and the inferonasal GCIPL, and these parameters were correlated concurrently. Both modalities showed a good diagnostic value for discriminating VFDs.
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Affiliation(s)
- Hiebum Suh
- Department of Radiology (HBS), Pusan National University School of Medicine, Busan, South Korea ; Department of Ophthalmology (HC, HJ), Pusan National University Hospital, Busan, South Korea ; and Biomedical Research Institute (HC, HJ), Pusan National University Hospital, Busan, South Korea
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Changes of Peripapillary Region Perfusion in Patients with Chiasmal Compression Caused by Sellar Region Mass. J Ophthalmol 2021; 2021:5588077. [PMID: 34221493 PMCID: PMC8219428 DOI: 10.1155/2021/5588077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/04/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose To evaluate the peripapillary vessel density (pVD) and the peripapillary nerve fiber layer (pRNFL) thickness in patients with chiasmal compression caused by sellar region mass using optical coherence tomography angiography (OCTA). Methods This is an observational, cross-sectional study of 31 patients (31 eyes) with chiasmal compression caused by sellar region mass and 34 healthy controls (34 eyes). Automated perimetry and OCTA were performed. The pVD and pRNFL thickness were compared between the two groups. The impact of tumor diameter, duration of symptoms, and cavernous sinus (CS) invasion on visual dysfunction, pVD, and pRNFL thickness was also analyzed. Furthermore, we divided the patients into two subgroups according to whether there was an absolute defect in the central visual field and evaluated their pVD and pRNFL thickness, respectively. Results Compared to the healthy control group, there was a statistically significant decrease in pVD and pRNFL thickness in patients with chiasmal compression (p < 0.05), especially in patients with substantial absolute defects in the central visual field. Tumor diameter, duration of symptoms, and CS invasion did not appear to be associated with pVD and pRNFL thickness. There was a significant positive correlation between the pVD and pRNFL thickness in patients with chiasmal compression (p < 0.001). Conclusion pVD and pRNFL thickness are significantly decreased in patients with chiasmal compression revealed by OCTA, especially in patients with more severe visual field defects. A significant correlation between pVD and pRNFL thickness was demonstrated, which provides a clue for the study of the mechanism of changes in retinal perfusion in compressive optic neuropathy. It requires considerable attention that OCTA may play an important role in disease monitoring of sellar region mass. Hence, further studies are needed to verify whether OCTA is helpful to predict the prognosis of visual function after decompression surgery.
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Qin J, Li K, Wang X, Bao Y. A comparative study of functioning and non-functioning pituitary adenomas. Medicine (Baltimore) 2021; 100:e25306. [PMID: 33832102 PMCID: PMC8036017 DOI: 10.1097/md.0000000000025306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/03/2021] [Indexed: 01/05/2023] Open
Abstract
Pituitary tumors commonly cause visual impairment and the degree of impairment can depend on the size, location, and type of the tumor. However, no studies have been made regarding the differences caused by functioning pituitary adenoma (FPA) and non-functioning pituitary adenoma (NFPA). We aimed to investigate the relationship between clinical characteristics and visual impairment in patients with FPA and NFPA.This case series study included 73 pituitary adenoma patients. All patients underwent ophthalmic evaluations, and we retrospectively reviewed their medical records. Tumor types were confirmed by histological analysis, and the tumor volume was calculated. Magnetic resonance imaging was used to determine the tumor diameter. The observation indices of the two groups were compared. The correlation between the visual field and tumor volume was analysed using scatter plots.We enrolled 30 patients in the FPA group and 43 in the NFPA group. The first symptoms presented in the eyes in 23% of FPA patients and 41.9% of NFPA patients. The best-corrected visual acuity of the FPA group was better than that of the NFPA group, and 34 (56.7%) and 73 (84.9%) eyes in these groups had visual field defects, respectively. The visual field defects of the FPA patients were lighter than those of the NFPA patients. Except for the anteroposterior diameter, there were no differences in the other parameters of tumor diameter between the groups. The tumor volume of the FPA group was smaller than that of the NFPA group. The tumor size was positively correlated with the mean deviation and negatively correlated with the mean sensitivity in both groups.There was a longer delay between the onset of signs and symptoms and treatment in the FPA group than in the NFPA group. Future studies should focus on visual field defects caused by FPA and NFPA.
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Affiliation(s)
- Jiayin Qin
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Xi Cheng District
- Department of Ophthalmology
| | - Kai Li
- Department of Neurosurgery, Peking University International Hospital, Life Science Park of Zhong Guancun, Chang Ping District, Beijing, China
| | | | - Yongzhen Bao
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Xi Cheng District
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Wang MTM, King J, Symons RCA, Stylli SS, Meyer J, Daniell MD, Savino PJ, Kaye AH, Danesh-Meyer HV. Prognostic Utility of Optical Coherence Tomography for Long-Term Visual Recovery Following Pituitary Tumor Surgery. Am J Ophthalmol 2020; 218:247-254. [PMID: 32533947 DOI: 10.1016/j.ajo.2020.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the association between optical coherence tomography (OCT) parameters and long-term visual recovery following optic chiasm decompression surgery. DESIGN Prospective cohort study. METHODS Consecutive patients who underwent pituitary or parasellar tumor resection between January 2009 to December 2018 were recruited in a single-center, 2-year prospective, longitudinal cohort study. Best-corrected visual acuity, visual fields, and OCT retinal nerve fiber layer (RNFL) thickness, macular thickness and volume were assessed preoperatively, and at 6 weeks, 6 months, and 2 years postoperatively. Long-term visual field recovery and maintenance were defined as a mean deviation of >-3 at 24 months, and visual acuity recovery and maintenance were defined as a logarithm of minimal angle of resolution (logMAR) of 0 (Snellen 20/20) or better at 24 months. RESULTS A total of 239 patients (129 men, 110 women; mean ± SD age: 52 ± 16 years) were included. Multiple logistic regression analysis demonstrated that increased inferior RNFL thickness (per 10 μm) was associated with higher odds of long-term visual field recovery and maintenance (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.12-1.41; Q < 0.001), and greater superior RNFL thickness (per 10 μm) was associated with higher odds of visual acuity recovery and maintenance (OR: 1.13; 95% CI: 1.03-1.27; Q = 0.031). A multivariable risk prediction model developed for long-term visual field recovery and maintenance that incorporated age, preoperative visual function, and RNFL thickness demonstrated C-statistics of 0.83 (95% CI: 0.72-0.94). CONCLUSION Preoperative RNFL thickness was associated with long-term visual recovery and maintenance following chiasmal decompression. The multivariable risk prediction model developed in the present study may assist with preoperative patient counseling and prognosis.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - James King
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - R C Andrew Symons
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stanley S Stylli
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joos Meyer
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Ophthalmology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark D Daniell
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia; Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Peter J Savino
- Shiley Eye Institute, University of California, San Diego, California, USA
| | - Andrew H Kaye
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia; Department of Neurosurgery, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
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Kotoda Y, Kotoda M, Ogiwara M, Kinouchi H, Iijima H. Left-Right and Upper-Lower Light Sensitivity Asymmetry in Visual Field Defects Caused by Pituitary Adenoma: A Retrospective Observational Study. Clin Ophthalmol 2020; 14:317-324. [PMID: 32099316 PMCID: PMC6999783 DOI: 10.2147/opth.s234422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to quantitatively investigate light sensitivity asymmetry both between left and right eyes and between upper and lower quadrant in the 30-degree visual field of patients with visual field defects caused by pituitary adenoma. Patients and Methods Preoperative Humphrey 30–2 perimetry results were reviewed retrospectively using the charts of 28 pituitary adenoma patients who underwent surgery. Inter-eye light sensitivity comparisons of the temporal and nasal hemifields between the left and right eyes were conducted in each patient to study left-right asymmetry. Upper-lower asymmetry was investigated by comparing the frequency of severe scotoma (light sensitivity 5 dB or less) in the upper and lower visual field quadrants in the temporal and nasal hemifields. Results Left-right asymmetry was demonstrated in 61% of cases in the temporal hemifield and in 57% of cases in the nasal hemifield. Severe scotoma test points were investigated in the worse eye of each patient and were more frequent in the superotemporal quadrant of the visual field compared with the inferotemporal quadrant (P = 0.00029) and in the inferonasal quadrant compared to the superonasal quadrant (P = 0.00268). Conclusion Asymmetric visual field defects between left and right eyes are common in patients with pituitary adenoma. Severe scotoma is more frequent in the upper quadrant of the temporal hemifield and in the lower quadrant of the nasal hemifield.
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Affiliation(s)
- Yumi Kotoda
- Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masakazu Kotoda
- Department of Anesthesiology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Masakazu Ogiwara
- Department of Neurosurgery, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
| | - Hiroyuki Iijima
- Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan
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13
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Visual loss and recovery in chiasmal compression. Prog Retin Eye Res 2019; 73:100765. [DOI: 10.1016/j.preteyeres.2019.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
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14
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Lobão CAF, Miquilini L, da Silva BSR, da Silva VGR, Lacerda EMDCB, Rosa AAM, Souza GDS. Using sellar region tumor's size as a predictor of psychophysical and electrophysiological perimetric visual losses: a logistic regression approach. Doc Ophthalmol 2019; 139:235-245. [PMID: 31338649 DOI: 10.1007/s10633-019-09709-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sellar region tumor growth represents an important cause of visual loss due to mechanical compression of the optic nerve apparatus. Many investigations have used non-invasive tools to evaluate the visual field consequences of this damage, and good associations have been reported between psychophysical and electrophysiological perimetries. Few reports have considered the tumor size as a predictor of visual field loss. AIMS In the present study, we evaluated the association between the visual perimetry measured by Humphrey visual field analyzer and multifocal visual evoked cortical potential (mfVECP) and the tumor size. METHODS Our sample was composed of 14 patients diagnosed with sellar tumors by magnetic resonance imaging. We accounted the number of sectors with negative visual responses for both methods. A simple logistic regression analysis was used to evaluate the association between the tumor dimensions and the visual field features RESULTS: Three patients had preserved visual fields, three patients showed hemianopic defects, and eight patients had generalized visual field losses at both evaluations. We observed that the three maximum diameters of the tumor and total tumor volume had different predictive abilities regarding the extent of visual field loss when using psychophysical and mfVECP data. The maximum craniocaudal diameter of the tumor was the better predictor of the psychophysical measurements, whereas for the mfVECP results, all tumor dimensions and volumes had similar values that predict visual field losses. CONCLUSION Tumor size as a predictor of visual loss has potential to assist in the clinical intervention and to prevent the irreversible visual impairment caused by tumors of the sellar region.
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Affiliation(s)
| | - Letícia Miquilini
- Núcleo de Teoria e Pesquisa do Comportamento, Universidade Federal do Pará, Belém, Brazil
| | | | | | | | - Alexandre Antônio Marques Rosa
- Hospital Universitário Betina Ferro de Sousa, Universidade Federal do Pará, Belém, Brazil
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Brazil
| | - Givago da Silva Souza
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil.
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Av Generalíssimo Deodoro 92, Umarizal, Belém, Pará, 66055240, Brazil.
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15
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Batra R, Toogood A, Jacks AS. Bilateral inferior hemifield visual loss secondary to a pituitary prolactinoma. Can J Ophthalmol 2017; 52:e220-e225. [PMID: 29217048 DOI: 10.1016/j.jcjo.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ruchika Batra
- Birmingham Neuro-ophthalmology Unit, University Hospital Birmingham, Birmingham, United Kingdom.
| | - Andrew Toogood
- Department of Endocrinology, University Hospital Birmingham, Birmingham, United Kingdom
| | - Andrew Simon Jacks
- Birmingham Neuro-ophthalmology Unit, University Hospital Birmingham, Birmingham, United Kingdom
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Butz LB, Sullivan SE, Chandler WF, Barkan AL. "Micromegaly": an update on the prevalence of acromegaly with apparently normal GH secretion in the modern era. Pituitary 2016; 19:547-551. [PMID: 27497970 DOI: 10.1007/s11102-016-0735-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Approximately 25 % of cases of clinically active acromegaly cases treated in our academic center between 1996 and 2000, were diagnosed in patients who had elevated plasma IGF-1 levels, but apparently "normal" 24-h mean plasma GH levels. The current study served to update the data for patients with acromegaly referred to our facility, after increasing awareness of this "normal" GH subpopulation throughout the medical community. METHODS A retrospective chart review was conducted on 157 patients with acromegaly who underwent resection of a confirmed somatotroph pituitary adenoma at the University of Michigan Health System between the dates of 1 Jan 2001 to 23 Sept 2015. RESULTS Overall prevalence of acromegalic patients with "normal" GH levels, defined as GH <4.7 ng/mL, was 31 %. Over time, the percentage of patients with "normal" GH at diagnosis did not decline: 26 % from 2001 to 2005, 19 % from 2006 to 2010, and 47 % from 2011 to 2015. Mean pituitary tumor size was 1.8 ± 0.1 cm for the group with elevated GH, and 1.2 ± 0.1 cm for the group with "normal" GH (p < 0.001). Percent microadenomas was higher in a group with "normal" GH as compared to those with elevated GH (48 vs. 12 %, p < 0.001), and tumors >2 cm in the maximal diameter were encountered more frequently in the group with elevated GH (43 vs. 14 %, p < 0.001). CONCLUSIONS Our data show that a substantial percentage of patients with clinical acromegaly have "normal" GH, and therefore strengthens the growing body of evidence which supports the leading role of IGF-1 levels in diagnostic evaluation. At the present time, questions about the natural course of "micromegaly" and treatment benefits compared to the subpopulation with elevated GH levels remain unanswered, but research continues to build on our understanding of the heterogeneous population of individuals.
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Affiliation(s)
- Laura B Butz
- Division of Metabolism, Endocrinology, and Diabetes, Internal Medicine Department, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, P.O. Box 482, Ann Arbor, MI, 48106, USA
| | - Stephen E Sullivan
- Department of Neurosurgery and the Pituitary and Neuroendocrine Center, University of Michigan, Ann Arbor, MI, USA
| | - William F Chandler
- Division of Metabolism, Endocrinology, and Diabetes, Internal Medicine Department, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, P.O. Box 482, Ann Arbor, MI, 48106, USA
- Department of Neurosurgery and the Pituitary and Neuroendocrine Center, University of Michigan, Ann Arbor, MI, USA
| | - Ariel L Barkan
- Division of Metabolism, Endocrinology, and Diabetes, Internal Medicine Department, University of Michigan, 24 Frank Lloyd Wright Drive, G-1500, P.O. Box 482, Ann Arbor, MI, 48106, USA.
- Department of Neurosurgery and the Pituitary and Neuroendocrine Center, University of Michigan, Ann Arbor, MI, USA.
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17
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Urrets-Zavalía JA, Espósito E, Garay I, Monti R, Ruiz-Lascano A, Correa L, Serra HM, Grzybowski A. The eye and the skin in endocrine metabolic diseases. Clin Dermatol 2016; 34:151-65. [DOI: 10.1016/j.clindermatol.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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Visual Defects in Patients With Pituitary Adenomas: The Myth of Bitemporal Hemianopsia. AJR Am J Roentgenol 2016; 205:W512-8. [PMID: 26496573 DOI: 10.2214/ajr.15.14527] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to test the hypothesis that bitemporal hemianopsia (BHA) is the most common visual field (VF) defect in patients with pituitary macroadenoma and to assess the degree of optic pathway compression necessary to produce visual defects. MATERIALS AND METHODS We reviewed the MRI findings and medical records of 119 patients with pituitary macroadenoma who had undergone formal assessment of VFs. We then evaluated the degree of optic pathway displacement caused by the pituitary macroadenoma, as observed on MR images. The classifications of optic pathway displacement included no contact, abutment but no displacement, mild displacement (< 3 mm), and moderate displacement (≥ 3 mm). Qualitative analysis classified VFs as normal or as having defects that were monocular, bitemporal, mixed (bitemporal with additional defects), homonymous, or nonspecific. RESULTS A total of 89 of 115 patients had an abnormal VF. Only one patient had true BHA. The most common defects were bitemporal or mixed defects (in 49 of 115 patients [42.6%]), likely because more than just the chiasm is often compressed by the pituitary macroadenoma. Classification of optic pathway displacement by the pituitary macroadenoma was as follows: 23 patients had no contact, eight had abutment but no displacement, 27 had mild displacement, and 57 had moderate displacement. In 78 of the 92 patients (84.8%) with pituitary macroadenoma that had contact with the optic pathway, contact was with the optic chiasm and the prechiasmal optic nerve. Of the 49 patients with bitemporal or mixed defects, 42 had moderate displacement of the optic pathway caused by their tumors. CONCLUSION BHA is exceedingly uncommon in patients with pituitary macroadenoma. However, although bitemporal and mixed defects are the most common abnormal VF findings, they were found in only 42.6% of patients. Such defects rarely occur if the tumor displaces the optic pathway less than 3 mm from baseline.
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Ho RW, Huang HM, Ho JT. The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. J Korean Neurosurg Soc 2015; 57:23-31. [PMID: 25674340 PMCID: PMC4323501 DOI: 10.3340/jkns.2015.57.1.23] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 03/26/2014] [Accepted: 04/06/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aims of this study were to investigate the quantitative relationship between pituitary macroadenoma size and degree of visual impairment, and assess visual improvement after surgical resection of the tumor. METHODS The medical records of patients with pituitary adenoma, who had undergone trans-sphenoidal adenectomy between January 2009 and January 2011, were reviewed. Patients underwent an ocular examination and brain MRI before and after surgery. The visual impairment score (VIS) was derived by combining the scores of best-corrected visual acuity and visual field. The relationship between VIS and tumor size/tumor type/position of the optic chiasm was assessed. RESULTS Seventy-eight patients were included (41 male, 37 female). Thirty-two (41%) patients experienced blurred vision or visual field defect as an initial symptom. Receiver operating characteristic curve analysis showed that tumors <2.2 cm tended to cause minimal or no visual impairment. Statistical analysis showed that 1) poor preoperative vision is related to tumor size, displacement of the optic chiasm in the sagittal view on MRI and optic atrophy, and 2) poorer visual prognosis is associated with greater preoperative VIS. In multivariate analysis the only factor significantly related to VIS improvement was increasing pituitary adenoma size, which predicted decreased improvement. CONCLUSION Results from this study show that pituitary adenomas larger than 2 cm cause defects in vision while adenomas 2 cm or smaller do not cause significant visual impairment. Patients with a large macroadenoma or giant adenoma should undergo surgical resection as soon as possible to prevent permanent visual loss.
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Affiliation(s)
- Ren-Wen Ho
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Mei Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jih-Tsun Ho
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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20
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Ogra S, Nichols AD, Stylli S, Kaye AH, Savino PJ, Danesh-Meyer HV. Visual acuity and pattern of visual field loss at presentation in pituitary adenoma. J Clin Neurosci 2014; 21:735-40. [PMID: 24656736 DOI: 10.1016/j.jocn.2014.01.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
Our purpose was to analyse the demographics, prevalence and pattern of visual field defects in patients with pituitary adenoma. We prospectively recruited 103 consecutive patients (206 eyes) presenting to a neurosurgical unit with pituitary adenoma. Ophthalmological examination and standard automated perimetry (Humphrey, 24-2 threshold) was performed. Severity of visual field defects was also assessed. The mean population age was 53.9 years (standard deviation=15). Visual loss was the most common reason for presentation (39%) followed by endocrine abnormality (21%) and headache (15%). Patients with endocrine abnormality on presentation were 10.9 years younger than those presenting with visual loss (p=0.001). Bitemporal defects were the most prevalent pattern (n=22, 41%) followed by homonymous defects (n=7, 13%). Of the patients with visual field loss, 33% had unilateral visual field defects. The mean visual acuity in those with bitemporal defects was 6/7.5 with half of these patients having 6/6 vision in both eyes. In conclusion, the majority of patients with pituitary adenoma have visual acuity better than 6/7.5 despite having visual field defects. While a bitemporal pattern of visual field loss is the most common, a significant proportion of patients had unilateral and altitudinal defects. Assessment of the visual field is essential to rule out chiasmal compression.
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Affiliation(s)
- Siddharth Ogra
- Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Andrew D Nichols
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Stanley Stylli
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andrew H Kaye
- Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Helen V Danesh-Meyer
- Department of Ophthalmology, Faculty of Medical & Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
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21
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Visual field defects in 23 acromegalic patients. Int Ophthalmol 2013; 33:521-5. [DOI: 10.1007/s10792-013-9733-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Abstract
Acromegaly is a chronic disease characterized by the presence of a pituitary growth hormone (GH)-producing tumour, excessive secretion of growth hormone, raised levels of insulin-like growth factor I (IGF-I) and characteristic clinical presentation of acral enlargement. Over the past two decades, major advances have occurred in the understanding of some aspects of acromegaly--such as the biology of pituitary tumours, the physiology, molecular mechanisms of GH secretion and IGF-I generation, and the pathogenesis of comorbidities. Moreover, new approaches to diagnosis and surveillance (both in terms of screening and follow-up) of acromegaly have led to increases in the number of patients diagnosed with active disease, many of whom would previously have been missed. The development of sensitive assays for detecting plasma GH and IGF-I levels, as well as the widespread use of MRI for visualization of small tumours, have been major contributing factors to these improvements. Treatment advances have resulted in improved cure rates and disease control through novel neurosurgical techniques and pharmacological approaches. This Review summarizes and discusses the changes in our understanding of the epidemiology, diagnosis, treatment, and follow-up of acromegaly and its comorbidities.
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Affiliation(s)
- Antônio Ribeiro-Oliveira
- Federal University of Minas Gerais, Department of Internal Medicine, Rua Alfredo Balena 110, Belo Horizonte, MG 30330-120, Brazil
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Lee MJ, Hwang JM. Initial visual field as a predictor of recurrence and postoperative visual outcome in children with craniopharyngioma. J Pediatr Ophthalmol Strabismus 2012; 49:38-42. [PMID: 21323242 DOI: 10.3928/01913913-20110208-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/13/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to investigate the significance of the initial visual field as a predictor of recurrence of craniopharyngioma and postoperative visual outcome in children with craniopharyngioma. METHODS A retrospective analysis was performed on 27 children 15 years of age or younger with craniopharyngioma. Records of clinical features including ocular and systemic symptoms, optic disc findings, and size of the tumor were analyzed according to preoperative visual field. Postoperative visual acuities, visual fields, and recurrence rates were also evaluated. RESULTS Preoperatively, 13 patients had a normal visual field and 14 patients had various visual field defects. The size of the tumor was not correlated with the preoperative visual field defects (P = .15). Preoperative visual field defects were associated with polyuria and polydipsia (P = .01), higher recurrence (P < .001), and poorer postoperative visual acuities (P < .001). CONCLUSION Preoperative visual field can be a reliable clinical indicator of systemic manifestations, recurrence, and postoperative visual outcome in children with craniopharyngioma.
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Affiliation(s)
- Min Joung Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
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Katznelson L, Atkinson JLD, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly--2011 update. Endocr Pract 2011; 17 Suppl 4:1-44. [PMID: 21846616 DOI: 10.4158/ep.17.s4.1] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Laurence Katznelson
- Departments of Medicine and Neurosurgery, Stanford University, Stanford, California, USA
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Abstract
In the first part of this chapter the anatomy and vascular supply of the chiasm are recounted, and the visual symptoms that may arise in chiasmal disease are noted. The neuro-ophthalmic signs, including the pattern of visual field defects, appearance of the optic disc, and various uncommon clinical accompaniments, are described. The second part deals with a comprehensive list of disease processes that may directly or indirectly affect the chiasm. These are divided into inflammatory disorders, including sarcoidosis, multiple sclerosis, and idiopathic chiasmitis; infective disorders, including tuberculosis; and a large section on tumors, including pituitary adenomas, cysts, and choristomas, malignant disorders, including germ cell tumors and glioma, and meningioma; and finally vascular disorders and compression due to hydrocephalus. In each case the clinical features and management of the disorder are noted, as well as the prognosis for visual improvement following treatment.
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Affiliation(s)
- Desmond Kidd
- Department of Neuro-ophthalmology, Royal Free Hospital and Royal Free and University College Hospital Medical School, London, UK.
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Kedar S, Ghate D, Corbett JJ. Visual fields in neuro-ophthalmology. Indian J Ophthalmol 2011; 59:103-9. [PMID: 21350279 PMCID: PMC3116538 DOI: 10.4103/0301-4738.77013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 12/26/2010] [Indexed: 11/04/2022] Open
Abstract
Visual field assessment is important in the evaluation of lesions involving the visual pathways and should be performed at baseline and periodically in the follow-up. Standard automated perimetry has been shown to be adequate in neuro-ophthalmic practise and is now the technique of choice for a majority of practitioners. Goldman kinetic visual fields are useful for patients with severe visual and neurologic deficits and patients with peripheral visual field defects. Visual fields are useful in monitoring progression or recurrence of disease and guide treatment for conditions such as idiopathic intracranial hypertension (IIH), optic neuropathy from multiple sclerosis, pituitary adenomas, and other sellar lesions. They are used as screening tools for toxic optic neuropathy from medications such as ethambutol and vigabatrin. Visual field defects can adversely affect activities of daily living such as personal hygiene, reading, and driving and should be taken into consideration when planning rehabilitation strategies. Visual field testing must be performed in all patients with lesions of the visual pathway.
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Affiliation(s)
- Sachin Kedar
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA.
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Lee JP, Park IW, Chung YS. The volume of tumor mass and visual field defect in patients with pituitary macroadenoma. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:37-41. [PMID: 21350693 PMCID: PMC3039193 DOI: 10.3341/kjo.2011.25.1.37] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 09/05/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.
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Affiliation(s)
- Jung Pil Lee
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Nishimura M, Kurimoto T, Yamagata Y, Ikemoto H, Arita N, Mimura O. Giant Pituitary Adenoma Manifesting As Homonymous Hemianopia. Jpn J Ophthalmol 2007; 51:151-3. [PMID: 17401630 DOI: 10.1007/s10384-006-0419-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Accepted: 10/19/2006] [Indexed: 11/25/2022]
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Abstract
Growth hormone (GH) is synthesised and secreted by the somatotroph cells of the anterior lobe of the pituitary gland. Its actions involve multiple organs and systems, affecting postnatal longitudinal growth as well as protein, lipid, and carbohydrate metabolism. GH hypersecretion results in gigantism or acromegaly, a condition associated with significant morbidity and mortality, while GH deficiency results in growth retardation in children and the GH deficiency syndrome in adults. This article, aimed at non-paediatric physicians, examines the clinical features, diagnosis, and current concepts in the management of these conditions.
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Affiliation(s)
- J Ayuk
- Division of Medical Sciences, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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Abstract
PURPOSE OF REVIEW This review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism. RECENT FINDINGS Although a number of modalities have been used to assess visual function in patients with chiasmal disorders, perimetry remains the most effective means of detecting and following the visual deficit. SUMMARY Most chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.
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Affiliation(s)
- Rod Foroozan
- Cuullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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van den Bergh ACM, Dullaart RPF, Hoving MA, Links TP, ter Weeme CA, Szabó BG, Pott JWR. Radiation optic neuropathy after external beam radiation therapy for acromegaly. Radiother Oncol 2003; 68:95-100. [PMID: 12972302 DOI: 10.1016/s0167-8140(03)00202-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Alfons C M van den Bergh
- Department of Radiation Oncology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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