Neuro-ophthalmological aspects of large and giant pituitary adenomas
Background. Pituitary adenomas (PA) are tumors developing from adenohypophysis cells, make up 20–25 % of all extracerebral intracranial tumors. In hormonally active PA secreting different hormones, corresponding clinical syndromes develop and the diagnosis is made in small tumor sizes, at an early stage of the disease. Non-functioning PA presented as macroadenomas are characterized by neurological symptoms due to an increase in intracranial mass of tissue, while hormonal inactivity leads to a delay in diagnosis compared with functioning PA. Visual disorders can result in blindness in 3.5–16 % of patients. The purpose was to study the features of visual disorders in patients with large and giant pituitary adenomas in the dynamics of observation. Materials and methods. We observed 54 patients with PA using clinico-neurological, ophthalmological and neuroimaging methods. Results. Patients with large and giant PA are characterized by a long history of the disease (up to 7 years) with onset in the age from 45 to 59 years, the prevalence of hormonally inactive PA. In the clinical course, visual disturbances prevailed, with the development of asymmetric chiasmal syndrome characterized by severe and very severe vision loss, absolute defects in the temporal halves of the field of vision and primary atrophy of the optic nerves. With dynamics of observation, it has been found that neurosurgical treatment leads to stabilization of visual acuity and visual field. Conclusions. The large and giant pituitary adenomas are characterized by significant disorder in visual functions: visual acuity and visual field, and the development of primary atrophy of the optic nerves. It is necessary to note the leading role of timely neurosurgical treatment for stabilization of visual functions.
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