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Visual Loss in Pregnant Women with Pituitary Adenomas

Mark J. Kupersmith, MD; Carl Rosenberg, PhD; and David Kleinberg, MD
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From New York University Medical Center and the Department of Veterans Affairs Medical Center, New York, New York. Requests for Reprints: Mark J. Kupersmith, MD, Departments of Ophthalmology and Neurology, New York University Medical Center, 530 First Avenue 3B, New York, NY 10016. Grant Support: In part by Sandoz Pharmaceutical, Inc; Research to Prevent Blindness; R.L. Kohns Foundation; and a Department of Veterans Affairs Merit Review.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(7):473-477. doi:10.7326/0003-4819-121-7-199410010-00001
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Objective: To investigate the potential risk for developing visual loss during single or multiple pregnancies in women with pituitary adenomas.

Design: Cohort study.

Setting: Referral center of a neuro-ophthalmology service.

Patients: 65 consecutive women with pituitary adenomas who had not been previously treated with surgery or radiation were monitored during 111 pregnancies. Sixty had increased levels of serum prolactin or growth hormone and 5 did not.

Main Outcome Measures: Visual field or acuity loss was compared with the baseline size of the adenoma measured on the coronal view of the computed tomographic or magnetic resonance image.

Results: Computed tomography or magnetic resonance imaging showed a definitive tumor (>0.3 cm, vertical height) in 57 patients, 8 of whom had macroadenomas (≥ 1.1 cm). Visual field loss occurred in 6 of 8 primiparous patients, all with adenomas greater than 1.1 cm (range, 1.2 to 2.5 cm). None of the 57 patients (95% CI, 0% to 6.3%) with a microadenoma or presumed microadenoma of 1 cm or smaller developed visual loss after as many as four full-term pregnancies.

Conclusions: The risk for developing visual loss during single or multiple pregnancies in patients with microadenomas was small. Six of eight pregnant women with macroadenomas, however, developed visual field loss during pregnancy.


Grahic Jump Location
Figure 1.
Visual fields measured by tangent perimetry of patients 1 to 6 are listed (top to bottom) at the time that visual loss occurred during pregnancy.RL

The field from the right eye is on the right ( ) and that from the left eye is on the left ( ).

Grahic Jump Location




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