Glaucoma de ángulo abierto secundario a cortisona endógena por microadenoma hipofisario en un paciente joven, a propósito de un caso / Open angle glaucoma secondary to endogenous cortisone due to pituitary microadenoma in a young patient, a case report

CASO CLÍNICO: Varón de 31 años que fue derivado para valoración tras ser diagnosticado de síndrome de Cushing secundario a un microadenoma hipofisario. En la exploración se observó reducción de la agudeza visual y presión intraocular (PIO) de 48 mmHg en ambos ojos. El segmento anterior fue normal, la papila excavada y el ángulo abierto explorado mediante gonioscopia. Se realizó también campimetría que reveló una afectación avanzada. Se diagnosticó de glaucoma secundario a corticosteroides endógenos y se inició tratamiento médico a la espera de la extirpación del adenoma. La PIO no se normalizó tras la extirpación incompleta del adenoma, por lo que se optó por realizar trabeculectomía para controlarla. Como conclusiones: ante una hipertensión ocular con tumor hipofisario se debe sospechar glaucoma secundario a cortisona endógena; el tratamiento precoz del tumor es necesario para normalizar los niveles de la cortisona y controlar la PIO, el diagnóstico tardío o el tratamiento incompleto de estos tumores puede llevar a no obtener un control adecuado de la PIO

CASE REPORT: A 31-year-old male was referred for evaluation after being diagnosed with Cushing syndrome secondary to a pituitary microadenoma. He presented with a reduced visual acuity and high intraocular pressure (IOP) of 48mmHg in both eyes. The examination with biomicroscopy showed normal anterior segment, increased cup to disc ratio, and open angle. There was a moderate-advanced involvement in the visual field. The patient was diagnosed with glaucoma secondary to endogenous corticosteroids, and medical treatment was initiated pending the removal of the adenoma. The IOP did not return to normal after the incomplete removal of the adenoma, so a trabeculectomy was performed to control the IOP. As conclusions: In the case of an ocular hypertension with pituitary tumour, secondary glaucoma to endogenous cortisone should be suspected. Early treatment of the tumour is necessary to bring the cortisone and IOP levels back to normal. Late diagnosis or incomplete treatment of these tumours may lead to not obtaining adequate IOP control

Open angle glaucoma secondary to endogenous cortisone due to pituitary microadenoma in a young patient, a case report. / Glaucoma de ángulo abierto secundario a cortisona endógena por microadenoma hipofisario en un paciente joven, a propósito de un caso.

CASE REPORT: A 31-year-old male was referred for evaluation after being diagnosed with Cushing syndrome secondary to a pituitary microadenoma. He presented with a reduced visual acuity and high intraocular pressure (IOP) of 48mmHg in both eyes. The examination with biomicroscopy showed normal anterior segment, increased cup to disc ratio, and open angle. There was a moderate-advanced involvement in the visual field. The patient was diagnosed with glaucoma secondary to endogenous corticosteroids, and medical treatment was initiated pending the removal of the adenoma. The IOP did not return to normal after the incomplete removal of the adenoma, so a trabeculectomy was performed to control the IOP. As conclusions: In the case of an ocular hypertension with pituitary tumour, secondary glaucoma to endogenous cortisone should be suspected. Early treatment of the tumour is necessary to bring the cortisone and IOP levels back to normal. Late diagnosis or incomplete treatment of these tumours may lead to not obtaining adequate IOP control.