GLOKOM TANISI İLE TAKİP EDİLEN HASTADA HİPOFİZ ADENOMU TESPİTİ

Bilateral glokom tanısı ile izlenen hasta kontrol amacıyla göz polikliniğimize başvurdu. Özgeçmişinde başka bir hastalığı olmayan hastanın göz içi basıncı her iki gözde dorzolomid timolol kombinasyonu ile 10 mmHg olarak tespit edildi. Her iki gözünün de görme keskinliği snellen eşeli ile 0,3 düzeyindeydi. Gonyoskopide her iki göz de açık açı izlenirken, psödoexfoliasyon izlenmedi. Arka segmentte ise her iki papillada solukluk tespit edildi. Papilladaki diffüz solukluğa çukurluk eşlik etmediği görüldü. Bu bulgularla glokom tanısından uzaklaşıp intrakranial patolojiden şüphelenildi. Hastadan görme alanı ve kranial MR istendi. Kranial MR’da 12x9 mm boyutlarında hipofiz adenomu, görme alanında konsantrik daralma tespit edildi ve hasta intrakranial cerrahiye yönlendirildi. Bu bulgular sonrası antiglokomatöz ilacı kesildi. Glokom tanısı koyulurken veya takibi sırasında mutlaka papilla çok iyi incelenmeli intrakranial kitleler akla getirilmeli ve atlanmamalıdır

Anahtar Kelimeler:

Glokom, hipofiz adenomu, optik sinir başı

DIAGNOSIS OF A PITUITARY ADENOMA IN ONE GLAUCOMA FOLLOW-UP PATIENT

The patient under bilateral glaucoma follow-up admitted to our clinic for routine control. The medical history of the patient was unremarkable, and his intraocular pressure was measured as 10 mmHg in both eyes with a combination of dorzolamide/timolol. Visual acuity was 0.3 on the Snellen Scale in both eyes. Slit lamp examination revealed bilateral nuclear cataracts in the anterior segment. Open-angle was detected in both eyes on gonioscopy, but pseudoexfoliation was not observed. Pallor was detected in the posterior segment of both papillas. It was observed that optic disc cupping did not accompany to diffuse pallor. On the basis of these findings, the diagnosis of glaucoma was abandoned but intracranial pathology was suspected. Visual field and cranial MRI were planned. Cranial MRI demonstrated 12x9 mm pituitary adenoma, and concentric visual field constriction and the patient was referred to intracranial surgery. Based on these results, antiglaucoma medication was stopped. Consequently, papilla should be carefully examined and intracranial masses should be considered during the diagnosis and follow-up

Keywords:

Glaucoma, pituitary adenoma, optic nerve head,

PDF

___

) Jonas JB & Budde WM. Optic nevre head apppearance in juvenile-onset chronichigh-pressure glaucoma and normal-pressure Ophthalmology 2000; 107: 704–11. glaucoma.
) Teng CC, De Moraes CG, Prata TS, et al. ß-Zone parapapillary atrophy and progression. Ophthalmology 2010; :909–15. of glaucoma
) Qu Y, Wang YX, Xu L, et al. Glaucoma-like optic neuropathy in patients with intracranial tumours Acta Ophthalmol. 2011; 89: e428– e433
) Frise´n L & Claesson M. Narrowing of the retinal arterioles in descending optic atrophy. A quantitative clinical study. Ophthalmology 1984; 91: –6.
) Jonas JB & Xu L . Parapapillary chorioretinal atrophy in normal- pressure glaucoma. Am J Ophthalmol a;115: 501–5. ) Jonas JB, Ferna´ ndez MC & Naumann GO. Parapapillary atrophy and nonglaucomatous damage. Invest Ophthalmol Vis Sci ; 32: 2942–7. caliber in optic nerve
) Greenfield DS, Siatkowski RM, Glaser JS, Schatz NJ, Parrish II RK.The Cupped Disc Who Needs Neuroimaging? Ophthalmology 1998; : 1866-74.
) Trobe JD, Glaser JS, Cassady J, et al. Nonglaucomatous excavation of the optic disc. Arch Ophthalmol ;98:1046–50.
) Blumenthal EZ, Girkin CA & Dotan S. Glaucomatous-like cupping asso ciated with slow-growing supra-sellar intracranial ophthalmol 2006; 30: 111–5. J Neuro
) Kashiwagi K, Okubo T & Tsukahara S. Association of magnetic resonance imaging of anterior optic pathway with glaucomatous visual field damage and optic disc cupping. J Glaucoma 2004; 13: 189–95.
Yazının alınma tarihi:16.01.12014 Kabül tarihi:10.02.2014 Online basım:15.02.2014