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Documenta Ophthalmologica

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Open Access 01-12-2018 | Review Article

The importance of the electrophysiological tests in the early diagnosis of ganglion cells and/or optic nerve dysfunction coexisting with pituitary adenoma: an overview

Authors: Ewelina Lachowicz, Wojciech Lubiński

Published in: Documenta Ophthalmologica | Issue 3/2018

Abstract

Background and methods

Based on the available literature, it is suggested, in the clinical evaluation of the chiasmal tumors, that the following electrophysiological tests: visual evoked potentials to pattern-reversal stimulation, multifocal visual evoked potentials (mfVEPs), and pattern electroretinogram (PERG) play an important role in the diagnosis of the optic nerve and retinal dysfunction in the course of pituitary tumors.

Results

Macroadenomas and also microadenomas may cause dysfunction of retinal ganglion cells (RGCs) and their axons, even in the absence of changes in the routine ophthalmological examination, retinal sensitivity in standard automated perimetry, and retinal nerve fiber layer thickness in optical coherent tomography. The most frequently observed changes in electrophysiological tests were as follows: in PVEPs—the crossed/uncrossed asymmetry distribution, altered waveform, increase in P100-wave peak time, and/or reduction in amplitude; in mfVEPs—the peak time prolongation and/or amplitude reduction in C1-wave; in PERG—the reduction in N95-wave amplitude and decreased N95:P50 amplitude ratio. Hemifield PVEPs were more often abnormal than full-field PVEPs. Multi-channel recording is recommended for the assessment of the anterior visual pathway. The use of mfVEP offers the possibility to register localized disturbances of the optic nerve and ganglion cells. Additionally, an amplitude of N95-wave reduction in PERG correlated with a lack of postoperative visual acuity recovery. The postoperative improvement in the visual field was found to be associated with a normal N95:P50 amplitude ratio. The RGCs dysfunction manifested by decrease in PhNR/b-wave amplitude ratio was associated with the worse visual fields outcome. A review of the literature summarizing the electrophysiological testing in the pituitary adenoma is discussed.

Conclusion

In patients with pituitary tumor, detection of the early dysfunction of the visual pathway may lead to modification of the medical treatment regimen and reduce the incidence of irreversible optic nerve damage.

Rennert J, Doerfler A (2007) Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 109(2):111–124CrossRef

Asa SL, Ezzat S (1998) The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev 19:798–827PubMed

Anderson D, Faber P, Marcovitz S, Hardy J, Lorenzetti D (1983) Pituitary tumors and the ophthalmologist. Ophthalmology 90(11):1265–1270CrossRef

Liu GT, Volpe NJ, Galetta SL (2010) Vision loss: disorders of the chiasm. In: Grant T, Liu MD, Volpe NJ, Galetta SL (eds) Neuro-ophthalmology: diagnosis and management, 2nd edn. Saunders/Elsevier, Philadelphia, 2(7):237–259

Herse P (2014) Pituitary macroadenoma: a case report and review. Clin Exp Optom 97(2):125–132CrossRef

Jayaraman M, Ambika S, Ganfhi RA, Bassi SR, Ravi P, Sen P (2010) Multifocal visual evoked potential recordings in compressive optic neuropathy secondary to pituitary adenoma. Doc Ophthalmol 121:197–204CrossRef

Delgrange E, Trouillas J, Maiter D, Donckier J, Tourniaire J (1997) Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study. J Clin Endocrinol Metab 82(7):2102–2107PubMed

Monsalves E, Larjani S, Godoy BL, Juraschka K, Carvalho F, Kucharczyk W, Kulkarni A, Mete O, Gentili F, Ezzat S, Zadeh G (2014) Growth patterns of pituitary adenoma and histopathological correlates. JCEM 99(4):1330–1338PubMed

Huang W, Molitch ME (2018) Management of nonfunctioning pituitary adenomas (NFAs): observation. Pituitary 21(2):162–167CrossRef

10.

Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27(5):485–534CrossRef

11.

Weiss MH, Teal J, Gott P, Wycoff R, Yadley R, Apuzzo ML, Giannotta SL, Kletzky O, March C (1983) Natural history of microprolactinomas: six-year follow-up. Neurosurgery 12(2):180–183CrossRef

12.

Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A (1989) The natural history of untreated hyperprolactinemia: a prospective analysis. J Clin Endocrinol Metab 68(2):412–418CrossRef

13.

Madrazo-Navarro I, Maldonado-León JA (1991) Campimetric alterations caused by pituitary microadenoma successfully treated by transsphenoidal adenomectomy. Arch Invest Med (Mex) 22(1):9–12

14.

Medvedev IuA, Savost’ianov TF, Denikina OE (1997) Hypophysis compression syndrome in the sella turcica: mechanisms of development, pathology. Arkh Patol 59(3):32–38PubMed

15.

Dawson BH (1958) The blood vessels of the human optic chiasma and their relation to those of the hypophysis and hypothalamus. Brain 81(2):207–217CrossRef

16.

Arafah BM, Prunty D, Ybarra J, Hlavin ML, Selman WR (2000) The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J Clin Endocrinol Metab 85(5):1789–1793PubMed

17.

Morgan JE (2004) Circulation and axonal transport in the optic nerve. Eye (Lond) 18(11):1089–1095CrossRef

18.

Cannavo S, De Natale R, Curto L, Li Calzi L, Trimarchi F (1992) Effectiveness of computer assisted perimetry in the follow-up of patient with pituitary microadenoma responsive to medical treatment. Clin Endocrinol 37:157–161CrossRef

19.

Gutowski NJ, Heron JR, Scase MO (1997) Early impairment of foveal magno- and parvocellular pathways in juxta chiasmal tumours. Vis Res 37(10):1401–1408CrossRef

20.

Ventura LM, Venzara FX III, Porciatti V (2009) Reversible dysfunction of retinal ganglion cells in non-secreting pituitary tumors. Doc Ophthalmol 118:155–162CrossRef

21.

Cioffi GA (2005) Ischemic model of optic nerve injury. Trans Am Ophthalmol Soc 103:592–613PubMedPubMedCentral

22.

Hershenfeld SA, Sharpe JA (1993) Monocular temporal hemianopia. Br J Ophthalmol 77:424–427CrossRef

23.

Brecelj J (2014) Visual electrophysiology in the clinical evaluation of optic neuritis, chiasmal tumours, achiasmia, and ocular albinism: an overview. Doc Ophthalmol 129(2):71–84CrossRef

24.

Holder GE (2006) Chiasmal and retrochiasmal lesions. In: Heckenlively JR, Arden GB (eds) Principles and practice of clinical electrophysiology of vision, vol 78, 2nd edn. MIT Press, Cambridge, pp 857–865

25.

Poon A, McNeill P, Harper A, O’Day J (1995) Patterns of visual loss associated with pituitary macroadenomas. Aust N Z J Ophthalmol 23(2):107–115CrossRef

26.

Donckier JE, Gustin T (2012) Pituitary incidentaloma: to operate or not to operate? Acta Chir Belg 112(4):255–260CrossRef

27.

Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, Vance ML (2011) Endocrine society. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(4):894–904CrossRef

28.

Serri O (1994) Progress in the management of hyperprolactinemia. N Engl J Med 331(14):942–944CrossRef

29.

Colao A, Abs R, Bárcena DG, Chanson P, Paulus W, Kleinberg DL (2008) Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clin Endocrinol (Oxf) 68(1):66–71CrossRef

30.

Molitch ME (2010) Prolactinomas and pregnancy. Clin Endocrinol (Oxf) 73(2):147–148

31.

Almalki MH, Alzahrani S, Alshahrani F, Alsherbeni S, Almoharib O, Aljohani N, Almagamsi A (2015) Managing prolactinomas during pregnancy. Front Endocrinol (Lausanne) 26(6):85

32.

Imran SA, Ur E, Clarke DB (2007) Managing prolactin-secreting adenomas during pregnancy. Can Fam Physician 53(4):653–658PubMedPubMedCentral

33.

Kupersmith MJ, Rosenberg C, Kleinberg D (1994) Visual loss in pregnant women with pituitary adenomas. Ann Intern Med 121(7):473–477CrossRef

34.

Witek P, Zielinski G (2013) Management of prolactinomas during pregnancy. Minerva Endocrinol 38(4):351–363PubMed

35.

Karaca Z, Tanriverdi F, Unluhizarci Kelestimur F (2010) Pregnancy and pituitary disorders. Eur J Endocrinol 162:453–475CrossRef

36.

Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, Wass JAH (2011) Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. JCEM 96(2):273–288PubMed

37.

Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A, Acromegaly Consensus Group (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517CrossRef

38.

Brecej J (1994) Electrodiagnostics of chiasmal compressive lesions. Int J Psychophysiol 16(2-3):263–272CrossRef

39.

Holder GE (1997) The pattern electroretinogram in anterior visual pathway dysfunction and its relationship to the pattern visual evoked potential: a personal clinical review of 743 eyes. Eye 11(6):924–934CrossRef

40.

Parmar DN, Sofat A, Bowman R, Bartlett JR, Holder GE (2000) Visual prognostic value of the pattern electroretinogram in chiasmal compression. Br J Ophthalmol 84:1024–1026CrossRef

41.

Piekarska A, Lubiński W, Palacz O (2003) Znaczenie badań perymetrycznych i elektrofizjologicznych w diagnostyce guzów przysadki mózgowej. Okulistyka 6:87–92

42.

Badiu C, Serbănescu A, Coculescu M (1996) Pattern visual evoked potentials represent an early index for the evolution of optic chiasma syndrome of tumoraletiology. Rom J Physiol 33(1–4):91–100PubMed

43.

Piekarska A, Lubiński W, Palacz O, Wieliczko W, Pynka S, Szych Z, Karczewicz D (2005) Znaczenie badań okulistycznych w wykrywaniu neuropatii nerwu wzrokowego towarzyszącej guzom przysadki mózgowej. Klin Ocz 7–9:431–436

44.

Holder GE, Bullock PR (1989) Visual evoked potentials in the assessment of patients with non-functioning chromophobe adenomas. J Neurol Neurosurg Psychiatry 52(1):31–37CrossRef

45.

Halliday AM, Halliday E, Kriss A, McDonald WI, Mushin J (1976) The pattern-evoked potential in compression of the anterior visual pathways. Brain 99(2):357–374CrossRef

46.

Halliday AM, Halliday L, Kriss A, McDonald WI, Mushin J (1976) Abnormalities of the pattern evoked potential in compression of the anterior visual pathways. Trans Ophthalmol Soc N Z 28:37–40PubMed

47.

Pietrangeli A, Jandolo B, Occhipinti E, Carapella CM, Morace E (1991) The VEP in evaluation of pituitary tumors. Electromyogr Clin Neurophysiol 31(3):163–165PubMed

48.

Odom JV, Bach M, Brigell M, Holder GE, McCulloch DLL, Mizota A, Tormene AP (2016) ISCEV standard for clinical visual evoked potentials. Doc Ophthalmol 133(1):1–9CrossRef

49.

Stark DJ, Lenton L (1981) Electrophysiological assessment of compressive lesions of anterior visual pathways. Aust J Ophthalmol 9(2):135–141CrossRef

50.

Danesh-Meyer HV, Caroll SC, Gaskin BJ, Gao A, Gamble GD (2006) Correlation of the multifocal visual evoked potential and standard automated perimetry in compressive optic neuropathy. Invest Ophthalmol Vis Sci 47:1458–1463CrossRef

51.

Semela L, Hedges TR, Vuong L (2007) Serial multifocal visual evoked potential recordings in compressive optic neuropathy. Ophthalmic Surg Lasers Imaging 38(3):250–253PubMed

52.

Hood DC, Odel JG, Winn BJ (2003) The multifocal visual evoked potential. J Neuroophthalmol 23(4):279–289CrossRef

53.

Piekarska A, Lubiński W, Gosławski W, Wieliczko W, Syrenicz A, Olszowski T, Karczewicz D (2008) Ocena przydatności badania mfVEP w diagnostyce guzów przysadki mózgowej. Klin Ocz 7–9:247–251

54.

Klistorner AI, Graham SL, Grigg J, Balachandran C (2005) Objective perimetry using the multifocal visual evoked potential in central visual pathway lesions. Br J Ophthalmol 89(6):739–744CrossRef

55.

Kaltwasser C, Horn FK, Kremers J, Juenemann A, Bergua A (2011) Objective visual field determination in forensic ophthalmology with an optimized 4-channel multifocal VEP perimetry system: a case report of a patient with retinitis pigmentosa. Doc Ophthalmol 123(2):121–125CrossRef

56.

Qiao N, Zhang Y, Ye Z, Shen M, Shou X, Wang Y, Li S, Wang M, Zhao Y (2015) Comparison of multifocal visual evoked potential, static automated perimetry, and optical coherence tomography findings for assessing visual pathways in patients with pituitary adenomas. Pituitary 18(5):598–603CrossRef

57.

Pojda-Wilczek D, Pojda SM, Hendryk S, Herba E, Zatorska B, Jochan K (2000) Visual system function in patients after surgery for intracranial tumors. Neurol Neurochir Pol 34(6):1173–1186PubMed

58.

Monteiro ML, Cunha LP, Costa-Cunha LV, Maia OO Jr, Oyamada MK (2009) Relationship between optical coherence tomography, pattern electroretinogram and automated perimetry in eyes with temporal hemianopia from chiasmal compression. Invest Ophthalmol Vis Sci 50(8):3535–3541CrossRef

59.

Cennamo G, Auriemma RS, Cardone D, Grasso LF, Velotti N, Simeoli C, Di Somma C, Pivonello R, Colao A, de Crecchio G (2015) Evaluation of the retinal nerve fibre layer and ganglion cell complex thickness in pituitary macroadenomas without optic chiasmal compression. Eye 29(6):797–802CrossRef

60.

Rangaswamy NV, Frishman LJ, Dorotheo EU, Schiffman JS, Bahrani HM, Tang RA (2004) Photopic ERGs in patients with optic neuropathies: comparison with primate ERGs after pharmacologic blockade of inner retina. Invest Ophthalmol Vis Sci 45(10):3827–3837CrossRef

61.

Gotoh Y, Machida S, Tazawa Y (2004) Selective loss of the photopic negative response in patients with optic nerve atrophy. Arch Ophthalmol 122(3):341–346CrossRef

62.

Tamada K, Machida S, Yokoyama D, Kurosaka D (2009) Photopic negative response of full-field and focal macular electroretinograms in patients with optic nerve atrophy. Jpn J Ophthalmol 53(6):608–614CrossRef

63.

Moon CH, Hwang SC, Kim BT, Ohn YH, Park TK (2011) Visual prognostic value of optical coherence tomography and photopic negative response in chiasmal compression. Invest Ophthalmol Vis Sci 52(11):8527–8533CrossRef

Title: The importance of the electrophysiological tests in the early diagnosis of ganglion cells and/or optic nerve dysfunction coexisting with pituitary adenoma: an overview
Authors: Ewelina Lachowicz
Wojciech Lubiński
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Documenta Ophthalmologica / Issue 3/2018
Print ISSN: 0012-4486
Electronic ISSN: 1573-2622
DOI: https://doi.org/10.1007/s10633-018-9659-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The importance of the electrophysiological tests in the early diagnosis of ganglion cells and/or optic nerve dysfunction coexisting with pituitary adenoma: an overview

Abstract

Background and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and methods

Results

Conclusion

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