Pituitary tumor in a patient with hydrocephalus: a diagnostic challenge

ABSTRACT Hydrocephalus is defined as ventricular dilation caused by increased intraventricular and intracranial pressure when untreated or due to treatment failure. Optical pathways can often cause optic atrophy due to the proximity to the lateral hazard when dilation occurs. Hydrocephalus can lead to optic atrophy, as well as other pathologies. Pituitary tumors share this same sign, in addition to causing bitemporal hemianopia when it compresses the optic chiasm. In addition, bitemporal hemianopia is the visual disturbance most commonly found in patients with pituitary tumors. Pituitary tumors, for example, have clinical manifestations that may be related to gland dysfunction, or to mechanisms of tumor expansion. Visual signs and symptoms are more linked to the mechanical effect of the tumor. Therefore, the patient usually seeks the ophthalmologist before the endocrinologist. In this case, we analyzed a patient with hydrocephalus who presented, at the same time, a pituitary tumor, and the ophthalmological investigation made all the difference in the treatment of the patient.

摘要：脑积水（Hydrocephalus）的定义为，未经治疗或治疗失败时，因脑室内压与颅内压升高所导致的脑室扩张。当脑室扩张发生时，视觉通路因紧邻相关侧方结构，常可引发视神经萎缩。脑积水可导致视神经萎缩及其他病理改变。垂体腺瘤（Pituitary tumors）也可出现此类体征，当其压迫视交叉（optic chiasm）时，还可引发双颞侧偏盲（bitemporal hemianopia）。此外，双颞侧偏盲是垂体腺瘤患者最常见的视觉障碍。以垂体腺瘤为例，其临床表现可与腺体功能异常相关，或与肿瘤增殖的病理机制有关。视觉相关的体征与症状更多与肿瘤的机械压迫效应相关。因此，患者通常会先就诊于眼科医师，而非内分泌科医师。本次研究中，我们分析了1例同时罹患脑积水与垂体腺瘤的患者，眼科检查对该患者的治疗起到了决定性作用。