Endocrine Abstracts

Introduction: Pituitary adenomas are common, and their impact on visual function is often significant, given the intimate relationship between the anterior pituitary and the optic pathways. Ocular symptoms may be indicative. Compressive optic neuropathy and oculomotor paralysis present a diagnostic challenge. This report details four cases where ocular manifestations played an essential role in establishing the diagnosis of pituitary macroadenomas.

Observation: Observation 1: A 63-year-old man with no significant medical history, presented with sudden-onset ptosis and diplopia. Ophthalmological examination revealed a complete paralysis of the third cranial nerve, and cerebral magnetic resonance imaging (MRI) showed a partially hemorrhagic macroadenoma. Observation 2: A 56-year-old man with no significant medical history, presented with complains of bilateral progressive visual loss. Visual acuity was reduced to 1/20 in the right eye and negative light perceptions in the left eye. The pupillary light reflex in the right eye was normal, but a positive Marcus Gunn sign was observed in the left eye. Fundoscopy revealed bilateral optic atrophy. Brain MRI identified a sellar and suprasellar macroadenoma. Observations 3 and 4: The other two patients were women aged 25 and 33, who presented with complain of persistent headaches and vomiting. Ophthalmological examination indicated preserved visual acuity and bilateral stage II papilledema on fundoscopy. Brain MRI revealed a macroadenoma with a mass effect on the optic chiasm. The endocrine investigations have concluded to a non-secreting pituitary macroadenoma in cases 2,3 and 4.

Conclusion: Pituitary adenomas can manifest as a tumor syndrome, an endocrine syndrome or an acute intrasellar syndrome. The tumor syndrome primarily involves ophthalmological signs related to compressive optic neuropathy. This is most often associated with non-functional pituitary adenomas. Consequently, their discovery is often delayed until the tumor syndrome stage. When the macroadenoma extends supra-sellar with compression of the optic chiasm and/or pituitary stalk, it results in stasis papilledema, most commonly bilateral, causing visual field deficits. It can manifest as oculomotor paralysis, primarily affecting the third cranial nerve. Brain MRI allows for the diagnosis of pituitary macroadenomas and provides a precise assessment of their extension. These clinical cases highlight the diverse clinical manifestations of pituitary macroadenomas, underscoring the importance of brain imaging and ophthalmological evaluation in the diagnosis and management of these conditions.