Tonari Masahiro, Nishikawa Yuko, Matsuo Junko, Mimura Masashi, Oku Hidehiro, Sugasawa Jun, Ikeda Naokado, Kurisu Yoshitaka, Ikeda Tsunehiko
Department of Ophthalmology, Osaka Medical College, Takatsuki-City, Japan.
Department of Neurosurgery, Osaka Medical College, Takatsuki-City, Japan.
Case Rep Ophthalmol. 2020 Mar 4;11(1):92-99. doi: 10.1159/000506392. eCollection 2020 Jan-Apr.
To report the case of a patient with adrenocorticotropic hormone (ACTH)-producing pituitary adenoma who developed a mental disorder after initial surgery that kept him from undergoing scheduled follow-up visits and who ultimately had a giant recurrent tumor that resulted in blindness.
A 37-year-old male presented with the primary complaint of decreased visual acuity (VA) in both eyes and visual field defects. Visual field examination revealed bitemporal hemianopia. Magnetic resonance imaging (MRI) showed a pituitary tumor of approximately 4 cm in diameter extending from the intrasellar region to the sphenoid sinus and the suprasellar region. Transnasal transsphenoidal surgery was performed. Immunostaining of tumor tissue collected intraoperatively showed ACTH-positive cells, thus leading to the diagnosis of ACTH-producing pituitary adenoma. Postoperatively, the patient reportedly developed mental disorder that possibly interfered with scheduled appointments or continuous follow-up visits for many years, so we had no postoperative data about the vision/visual filed. Seven years later, he presented with markedly decreased VA (i.e., no light perception) in both eyes. Fundus examination showed bilateral marked optic disc atrophy. MRI showed a larger than 8-cm diameter giant recurrent pituitary adenoma in the suprasellar region, for which craniotomy was performed for partial tumor resection. Preoperatively, his blood cortisol level was low, and the lesion was deemed a nonfunctioning pituitary adenoma. Postoperatively, no significant complications occurred, yet his VA was no light perception OD and light perception OS.
Clinicians should be aware that patients with ACTH-producing pituitary adenomas may develop a mental disorder following surgery and possibly be unable to undergo scheduled follow-up, thus illustrating the importance of establishing an adequate patient follow-up system.
报告1例促肾上腺皮质激素（ACTH）分泌型垂体腺瘤患者，该患者在初次手术后出现精神障碍，导致其无法按计划进行随访，最终出现巨大复发性肿瘤并导致失明。
一名37岁男性，主要症状为双眼视力下降（VA）和视野缺损。视野检查显示双颞侧偏盲。磁共振成像（MRI）显示一个直径约4 cm的垂体肿瘤，从鞍内区域延伸至蝶窦和鞍上区域。行经鼻蝶窦手术。术中收集的肿瘤组织免疫染色显示ACTH阳性细胞，从而诊断为ACTH分泌型垂体腺瘤。据报道，术后患者出现精神障碍，可能干扰了多年来的定期预约或持续随访，因此我们没有术后视力/视野的相关数据。7年后，他双眼视力明显下降（即无光感）。眼底检查显示双侧视神经乳头明显萎缩。MRI显示鞍上区域有一个直径大于8 cm的巨大复发性垂体腺瘤，为此进行了开颅手术以部分切除肿瘤。术前，他的血皮质醇水平较低，该病变被认为是无功能垂体腺瘤。术后未发生明显并发症，但他的视力右眼无光感，左眼仅有光感。
临床医生应意识到，ACTH分泌型垂体腺瘤患者术后可能出现精神障碍，进而可能无法按计划进行随访，这说明了建立完善的患者随访系统的重要性。
