Management of Giant Pituitary Tumors Affecting Vision in Nigeria

ObjectiveThe management of pituitary tumors has evolved considerably in the past few decades. One of the indices for effective surgical outcome is the size of the tumor on presentation. Reports from West and Central Africa have largely indicated late presentation with very large tumors. In the present study we examined this trend and the impact of late presentation on visual outcomes.MethodsThis is a retrospective analysis of the patterns of visual presentation of giant pituitary tumors and the factors that influenced treatment outcomes. We analyzed 44 patients who presented with pituitary tumors extending into the suprasellar region during a five-year period. All patients had computerized tomography or magnetic resonance imaging confirmation of their tumor.ResultsAbout 43% of patients were referred from ophthalmologists. The main symptoms were impaired vision (100%) and visual field defect was present in 47.1%. Optic atrophy was found in 38 eyes (43.1%) and 30% of the patients were already blind on presentation. An additional 23% were functionally blind. Five patients had hydrocephalus from third ventricle obstruction. Of those who had surgery, five patients had additional radiotherapy. There were no perioperative deaths but there were two deaths during follow-up. Vision improved in 14 patients, was unchanged in nine and deteriorated in two.ConclusionsTumors of the pituitary present late in developing countries resulting in increased morbidity. Intervention even at this stage results in visual improvement and efforts must be made to cascade this information to frontier health workers.