TY - JOUR
T1 - Visual morbidity in macroprolactinoma
T2 - A retrospective cohort study
AU - Rudman, Yaron
AU - Duskin-Bitan, Hadar
AU - Masri-Iraqi, Hiba
AU - Akirov, Amit
AU - Shimon, Ilan
N1 - Publisher Copyright:
© 2024 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd.
PY - 2024/12
Y1 - 2024/12
N2 - Objective: The management of visual field damage in patients with macroprolactinomas is a major therapeutic challenge. We aimed to study the visual morbidity associated with macroprolactinoma and its outcomes following medical and surgical treatment. We aimed to identify predictors of visual recovery. Methods: We retrospectively reviewed patient's data including clinical presentation, serial pituitary magnetic resonance imaging, laboratory tests, visual symptoms and neuro-ophthalmologic examination, visual field tests and optical coherence tomography tests. The main outcome was complete visual field recovery. Descriptive analyses were conducted. Predictors of visual recovery were investigated. Patients: The study cohort included 150 patients with macroprolactinoma [median follow-up, 6.0 years (interquartile range (IQR) 2.9–10.6)]. Results: At diagnosis, visual field defects were evident in 40 patients (26.7%). At the end of follow-up, 24 out of 39 available visual field tests (61.5%) exhibited complete recovery. Patients that achieved complete visual recovery had smaller macroadenomas at diagnosis [30.5 mm (15.0–80.0) vs. 42.0 mm (30.0–85.0), p <.01], lower baseline serum prolactin levels [1414 mcg/L (489–3586) vs. 4119 mcg/L (2715–6315), p <.01], lower rates of central hypogonadism (78.3% vs. 93.3%, p =.05) and central hypothyroidism (20.8% vs. 53.3%, p =.04), lower rates of compressive optic neuropathy (35.3% vs. 87.5%, p =.02) and a better visual acuity (better than 6/8 in both eyes, 93.7% vs. 28.6%, p <.01). Conclusions: In our cohort of 150 patients with macroprolactinoma, 40 patients (26.7%) presented with visual field defects, of which 61.5% achieved complete visual recovery with treatment. Patients that achieved complete visual recovery presented with smaller macroadenomas, lower serum prolactin levels, lower rates of central hypogonadism and central hypothyroidism, lower rates of compressive optic neuropathy and better visual acuity.
AB - Objective: The management of visual field damage in patients with macroprolactinomas is a major therapeutic challenge. We aimed to study the visual morbidity associated with macroprolactinoma and its outcomes following medical and surgical treatment. We aimed to identify predictors of visual recovery. Methods: We retrospectively reviewed patient's data including clinical presentation, serial pituitary magnetic resonance imaging, laboratory tests, visual symptoms and neuro-ophthalmologic examination, visual field tests and optical coherence tomography tests. The main outcome was complete visual field recovery. Descriptive analyses were conducted. Predictors of visual recovery were investigated. Patients: The study cohort included 150 patients with macroprolactinoma [median follow-up, 6.0 years (interquartile range (IQR) 2.9–10.6)]. Results: At diagnosis, visual field defects were evident in 40 patients (26.7%). At the end of follow-up, 24 out of 39 available visual field tests (61.5%) exhibited complete recovery. Patients that achieved complete visual recovery had smaller macroadenomas at diagnosis [30.5 mm (15.0–80.0) vs. 42.0 mm (30.0–85.0), p <.01], lower baseline serum prolactin levels [1414 mcg/L (489–3586) vs. 4119 mcg/L (2715–6315), p <.01], lower rates of central hypogonadism (78.3% vs. 93.3%, p =.05) and central hypothyroidism (20.8% vs. 53.3%, p =.04), lower rates of compressive optic neuropathy (35.3% vs. 87.5%, p =.02) and a better visual acuity (better than 6/8 in both eyes, 93.7% vs. 28.6%, p <.01). Conclusions: In our cohort of 150 patients with macroprolactinoma, 40 patients (26.7%) presented with visual field defects, of which 61.5% achieved complete visual recovery with treatment. Patients that achieved complete visual recovery presented with smaller macroadenomas, lower serum prolactin levels, lower rates of central hypogonadism and central hypothyroidism, lower rates of compressive optic neuropathy and better visual acuity.
KW - cabergoline
KW - pituitary macroadenoma
KW - prolactinoma
KW - surgery
KW - visual morbidity
UR - http://www.scopus.com/inward/record.url?scp=85201382958&partnerID=8YFLogxK
U2 - 10.1111/cen.15120
DO - 10.1111/cen.15120
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C2 - 39155611
AN - SCOPUS:85201382958
SN - 0300-0664
VL - 101
SP - 648
EP - 658
JO - Clinical Endocrinology
JF - Clinical Endocrinology
IS - 6
ER -