A Study on Ophthalmic Manifestations in Pituitary Gland Tumors

INTRODUCTION: Pituitary adenoma is a benign tumour that originates from the adenohypophyseal cells of the anterior lobe of pituitary gland. It accounts for 12% to 15% of all intracranial tumours. A spectrum of visual manifestations are seen with these tumours, ranging from the absence of any visual symptoms to severe visual field defects and loss of vision The clinical manifestations depend on the cell type of the tumour, hypo or hypersecretion of hormones, direction of local spread and compression of adjacent structures. Pituitary adenomas are of 2 types according to the size : microadenomas (≤10 mm) and macroadenomas (>10 mm). In comparison to men, women have a 2-fold increased risk of developing pituitary adenomas. Pituitary adenoma is a benign tumour, however, it has a tendency of recurrence. Clinical features of adenomas are either due to hypersecretion or hyposecretion of hormones or compression of pituitary adenoma to the surrounding structures. Pituitary gland is situated in the sella turcica, 10–13 mm below the optic chiasm. Therefore, when it increases in size, it can easily compress the optic nerve fibres at the chiasma. AIM OF THE STUDY: PRIMARY OBJECTIVES: 1. To study the various ophthalmic manifestations in cases of pituitary tumors. 2. To analyse the proportion of cases presenting with ophthalmic manifestations in cases diagnosed as pituitary adenoma on radiological imaging. SECONDARY OBJECTIVES: 1. To analyse the sensory visual disturbances like degree of visual loss, pattern of visual field defects and ocular motility defects, in diagnosed cases of pituitary adenomas. MATERIALS AND METHODS: Patients who are diagnosed with pituitary adenoma on radiological imaging, presenting in Squint and Neuro-ophthalmology services will be registered and evaluated during the study period. A detailed history of the patient, evaluation of visual acuity on a Snellen chart, extraocular movement and pupillary assessment, colour vision, visual field examination by 32 program on octopus field analyser octopus, slit lamp examination, and fundus examination will be done. INCLUSION CRITERIA: 1. Patients diagnosed as having pituitary tumour on radiological imaging 2. Age 25- 65 years. EXCLUSION CRITERIA: 1. Patients with other ocular pathologies affecting visual fields such as glaucoma, optic neuritis, retinitis pigmentosa. 2. Patients with pre-existing defective vision to due to other causes. 3. Patients with ocular media opacities. 4. Patients physically or mentally unfit for detailed ocular examination. SUMMARY: • Commonest Age group was more than 50 years (60%). Mean age 50.6 years. • Females were more commonly affected (72%). • Headache was the most common presenting complaint (80%). • Most of the Patients (62%) had visual acuity between 6/6 to 6/12. • Patients had Pituitary macroadenomas in 96% of cases compared to microadenomas. • Bitemporal hemianopia was the commonest visual field defect (57.9%). • 24% of the patients had no visual field defect. • 16% Patients had features of Optic Atrophy on Fundus examination. CONCLUSION: As the primary goal in the management of pituitary adenoma revolves around restoration of visual loss, a neuro-ophthalmic evaluation is essential for early detection, planning treatment and subsequent follow up. Although a bitemporal visual field defect is a pathognomonic ophthalmic finding in cases of pituitary adenomas, various other clinical features like headache, ophthalmoplegia, sensory visual disturbances, and other field defects were also noted in our study. Hence, a thorough clinical evaluation is warranted in pituitary adenomas