Visual manifestations features in rare cases of combined pathology: pituitary adenoma and multiple sclerosis

Abstract

Purpose: to study the changes of visual function in patients with combined pathology involving multiple sclerosis and pituitary adenoma. Material and methods . Four female patients (8 eyes) aged 18 to 41 were subject to standard and special eye examinations, which revealed decreased visual acuity (0.01 to 0.1) and central visual field defects. IOP was normal. To identify the cause of reduced visual acuity, the patients were subjected to optical coherence tomography, microperimetry, magnetic resonance imaging (MRI) of the brain and the orbits and tested for blood serum hormones. They were also consulted by a neurologist, neurosurgeon, and endocrinologist. Results. Three of the patients were diagnosed with optic neuritis while the fourth patient had optic disk atrophy. All patients showed changes in the visual field and in the electrophysiological parameters, as well as altered thickness of the nervous fibers of the peripaillary retina, signs of hyperemia and swelling, blurring of the disc margin, while one patient had temporal optic disk pallor. MRI of the orbits showed niduses of demyelination in the optic nerve of three patients. In all cases, MRI of the brain revealed pituitary microadenomas. Hormonal activity of pituitary microadenomas in the blood serum (cortisol and prolactin) was found to be normal. Conclusions. Visual impairment was mainly caused by a demyelinating process, which was confirmed by special examination techniques and opinions of non-ophthalmology specialists. Combined pathology of the type specified requires a change in the tactics of patient management, as it is still not known for sure how the pituitary adenoma affects the course of multiple sclerosis.