Working with opticians to improve diagnosis times for pituitary patients
Tired? Headaches? Weight gain? 1000s of people are suffering the pain and isolation of an undiagnosed pituitary condition, which can affect their hormones. The Pituitary Foundation is currently running a campaign with optometrists to raise awareness and try to decrease diagnosis times.
During a visual field test, if a patient struggles to see the dots of light at either side, or pressure is detected on the optic nerves, it may indicate a pituitary tumour. They should be referred to a hospital ophthalmologist, and then for an MRI scan and an appointment with an endocrinologist.
Undiagnosed patients may have experienced vision problems for weeks, and if left undiagnosed, pituitary tumours may damage a patient’s eye sight. Optometrists can use field vision tests to make life-changing diagnoses for potential pituitary patients.
Pituitary conditions are rare with vague symptoms including; headaches, vision problems, unexplained weight gain, tiredness, headaches and fertility issues.
These common problems mean pituitary conditions can be missed by GPs and therefore a referral from an optometrist could be life-changing. The most common problem with the pituitary gland occurs when a benign growth (often referred to as 'adenoma' or 'tumour') develops. This can cause the gland to produce excess hormone, or it can block hormone production, and lead to the symptoms described.
Specialist Endocrine Nurse, Alison Milne, says optometrists can be life-savers. She said: ‘People might arrive with non-specific complaints of eye sight changes and we need opticians to include pituitary conditions in their mental checklist. If opticians see anything amiss with the optic structures or can see any abnormality or swelling then that might point to a pituitary condition they should refer them on to a hospital ophthalmologist.’
She added: ‘It may be obvious, but it’s so easily missed and pituitary patients will typically suffer for years before being diagnosed. If a patient struggles to see the dots of light to either side of the dark screen, it may indicate a tumour near the pituitary gland which could be reducing the field of vision. Any tumour mass that grows on the pituitary gland can in time press on the optic nerve and cause persistent headaches and loss of vision which worsens as the tumour grows.’
Phil is a pituitary patient, and he describes being diagnosed immediately by his optician:
‘In October 1996, I finally admitted to myself that I had an issue with my sight. I visited an optician who listened to what I had to say, gave me a visual fields test, knew what he was looking at and sent me straight to my GP. After an MRI scan, I was diagnosed with a pituitary tumour - a benign macro adenoma which was pressing on my optic nerves and affecting my eyesight. Once I had taken some time to sort things out at work, I had transsphenoidal surgery at the Hospital in Sheffield - an operation through the back of my nose, which is still the most common surgical treatment for a pituitary tumour. Unfortunately, the tumour site bled, and ten days later I was losing large swathes of my eyesight. Faced with the bleak choice of another operation to my head - undesirable - and possibly losing my sight, I opted for more surgery, a craniotomy. The whole process felt surreal, from optician to GP to hospital to recovery, like it was happening to someone else while I watched. My sight recovered immediately, which was amazing.’
This patient story demonstrates just how quick a diagnosis and treatment can be when an optician is aware of pituitary tumours.
The Pituitary Foundation’s 2016 Survey asked patients approximately how many times they visited their GP about pituitary symptoms before diagnosis. 18.4% visited their GP over 20 times, 24.1% visited 7 – 20 times, 26.1% 3 to 6 times, and 31.3% visited just once or twice.
The Pituitary Foundation wants to work with opticians to improve diagnosis times. The more opticians who are made aware, the more patients can be diagnosed early and avoid the frustrations associated with a long diagnosis. Often patients are treated for other health conditions that they do not actually have which can be bewildering and is also an unnecessary cost to the NHS.
This year’s Pituitary Foundation October Awareness Month theme is about boosting optician awareness of pituitary tumours.
The Pituitary Foundation has an awareness poster which is aimed at people who may be sat in an optician waiting room (with possible pituitary conditions) to book a visual field test in store.
To get more information on pituitary conditions or to talk more about the difference that optometrists and ophthalmologists can make for pituitary patients, please contact The Pituitary Foundation. www.pituitary.org.uk/ 0117 370 1316.