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Grand Rounds Conference Eric Downing MD University of Louisville Department of Ophthalmology and Visual Sciences 2/20/15.

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Presentation on theme: "Grand Rounds Conference Eric Downing MD University of Louisville Department of Ophthalmology and Visual Sciences 2/20/15."— Presentation transcript:

1 Grand Rounds Conference Eric Downing MD University of Louisville Department of Ophthalmology and Visual Sciences 2/20/15

2 Subjective CC/HPI: 35 year old male with complaint of progressive decreased peripheral vision x 6 months. No flashes/floaters or blurry vision. CC/HPI: 35 year old male with complaint of progressive decreased peripheral vision x 6 months. No flashes/floaters or blurry vision. Review of Systems: denies dizziness, weakness, numbness, or headaches. Review of Systems: denies dizziness, weakness, numbness, or headaches.

3 History POH: none PMH: none Eye Meds: none Meds: none

4 Objective OD OS OD OS VA: 20/2020/25 Pupils: 4->24->2, no rAPD IOP:1313 EOM:full OU CVF: poor temporally OU

5 Objective PLE: E/L/L:WNL OU C/S:White, quiet OU KClear OU ACDeep & quiet I/LWNL OU VitWNL OU DFE: OD: ON c/d 0.4 with temp sloping, MVP WNL OS: ON c/d 0.4 sharp/pink, MVP WNL

6 GVF

7 MRI

8 MRI

9 MRI

10 Lab results Prolactin, T3, T4, TSH, cortisol, LH, FSH, and IGF-1 all WNL Prolactin, T3, T4, TSH, cortisol, LH, FSH, and IGF-1 all WNL

11 Assessment 35 year old male with painless progressive temporal vision loss for 6 months, bitemporal hemianopsia, and an MRI which revealed a pituitary mass. 35 year old male with painless progressive temporal vision loss for 6 months, bitemporal hemianopsia, and an MRI which revealed a pituitary mass. Dx: Pituitary Macroadenoma Dx: Pituitary Macroadenoma

12 Plan Referral to neurosurgery with subsequent transseptal sphenoidotomy Referral to neurosurgery with subsequent transseptal sphenoidotomy Scheduled for post-op VF Scheduled for post-op VF

13 Pituitary Adenoma Benign epithelial Benign epithelial Most common sellar mass, composing 10-15% of all intracranial tumors Most common sellar mass, composing 10-15% of all intracranial tumors Incidence is 1-7 cases per 100,000 Incidence is 1-7 cases per 100,000

14 Classification Size Size Microadenoma: <10mm Microadenoma: <10mm Macroadenoma: >10mm Macroadenoma: >10mm Activity Activity Functional (74%) Functional (74%) Non-functional (26%) Non-functional (26%) 95% present as macroadenomas 95% present as macroadenomas 2/3 of these patients have visual field defects 2/3 of these patients have visual field defects

15 Presentation Functioning Functioning Prolactinoma: amenorrhea, galactorrhea Prolactinoma: amenorrhea, galactorrhea Growth hormone: gigantism and/or acromegaly Growth hormone: gigantism and/or acromegaly ACTH: Cushing’s ACTH: Cushing’s TSH: weight loss, tachycardia, diarrhea TSH: weight loss, tachycardia, diarrhea Non-functioning Non-functioning Headache Headache VF defects VF defects

16 Treatment Observation Observation Medical: Bromocryptine for prolactinomas Medical: Bromocryptine for prolactinomas Surgery Surgery Radiotherapy Radiotherapy

17 Associated Syndromes Multiple Endocrine Neoplasia Type 1 Multiple Endocrine Neoplasia Type 1 Pituitary Adenomas (prolactinomas) Pituitary Adenomas (prolactinomas) Parathyroid Parathyroid Pancreatic Islet cell tumor Pancreatic Islet cell tumor Pituitary Apoplexy Pituitary Apoplexy Infarction of a pituitary tumor or sudden hemorrhage within Infarction of a pituitary tumor or sudden hemorrhage within Sudden onset of HA, vision loss, diplopia, and/or ptosis Sudden onset of HA, vision loss, diplopia, and/or ptosis

18 Research Investigated the degree of residual VF impairment with size of adenoma Investigated the degree of residual VF impairment with size of adenoma Retrospective analysis Retrospective analysis Divided groups based on vertical tumor size Divided groups based on vertical tumor size Created a Visual Impairment Score (VIS) Created a Visual Impairment Score (VIS) VA and VF defect parameters VA and VF defect parameters Results: tumors greater than 20mm result in persistent vision deficits, and should undergo surgical resection

19 References BCSC: Neuro-Ophthlamology. Pgs BCSC: Neuro-Ophthlamology. Pgs Pituitary Tumors: adenoma, craniopharyngioma, cysts. Mayfield Clinic and Spine Institute. Feb pgs 1-6 Pituitary Tumors: adenoma, craniopharyngioma, cysts. Mayfield Clinic and Spine Institute. Feb pgs 1-6 Ferrante E, Ferraroni M, Castrignano T, Menicatti L, Anagni M, Reimondo G, et al. Non-functioning pituitary adenoma database: a useful resource to improve clinical management of pituitary adenomas. Eur J Endocrinol 155: , Ferrante E, Ferraroni M, Castrignano T, Menicatti L, Anagni M, Reimondo G, et al. Non-functioning pituitary adenoma database: a useful resource to improve clinical management of pituitary adenomas. Eur J Endocrinol 155: , The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. Ren-Wan H, Hsiu-Mei H, Jih-Tsun H. J Korean Neurosug Soc 57(1): 23-31, 2015 The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. Ren-Wan H, Hsiu-Mei H, Jih-Tsun H. J Korean Neurosug Soc 57(1): 23-31, 2015


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