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Grand Rounds Conference

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Presentation on theme: "Grand Rounds Conference"— 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. Review of Systems: denies dizziness, weakness, numbness, or headaches. Ptosis – progressive over several years, OD > OS. Holds lids up to see.

3 History POH: none PMH: none Eye Meds: none Meds: none FOH: Glaucoma
FH: Cancer, stroke

4 Objective OD OS VA: 20/20 20/25 Pupils: 4->2 4->2, no rAPD
IOP: EOM: full OU CVF: poor temporally OU Levator function > 10 mm is excellent; < 5 is poor

5 Objective PLE: E/L/L: WNL OU C/S: White, quiet OU K Clear OU AC Deep & quiet I/L WNL OU Vit WNL OU DFE: OD: ON c/d 0.4 with temp sloping, MVP WNL OS: ON c/d 0.4 sharp/pink, MVP WNL





10 Lab results 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. Dx: Pituitary Macroadenoma

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

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

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

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

16 Treatment Observation Medical: Bromocryptine for prolactinomas Surgery
Radiotherapy Sjogren and Hashimoto thyroiditis; HIV

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

18 Research Investigated the degree of residual VF impairment with size of adenoma Retrospective analysis Divided groups based on vertical tumor size Created a Visual Impairment Score (VIS) 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 146-151
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: , 2006. 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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