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Zoia C, Todeschini G, Lovati E, Lucotti P, Iannalfi A, Bongetta D, Di Sabatino A, Riva G, Cavallo I, Orlandi E, Spena G. Evaluation of endocrinological sequelae following particle therapy performed on anterior skull base lesions in the adult population. Surg Neurol Int 2023; 14:293. [PMID: 37680918 PMCID: PMC10481810 DOI: 10.25259/sni_41_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
Background Radiotherapy has increasingly assumed a central role in the multidisciplinary treatment of skull base lesions. Unfortunately, it is often burdened by relevant radio-induced damage to the pituitary function and the surrounding structures and systems. Patients who were treated with radiotherapy around the sellar region especially have a high risk of developing radio-induced hypopituitarism. Particle therapy has the potential advantage of delivering a higher radiation dose to the target while potentially sparing the sellar region and pituitary function. The aim of this study is to evaluate the pituitary function in adult patients who have undergone hadron therapy for anterior skull base lesions involving or surrounding the pituitary gland. Methods This is a retrospective, observational, and noncontrolled study. We evaluated pituitary and peripheral hormone levels in all patients referring to National Center for Oncological Hadrontherapy, Pavia, Italy for anterior skull base tumors. Furthermore, we performed a magnetic resonance imaging for every follow-up to evaluate potential tumoral growth. Results We evaluated 32 patients with different tumoral lesions with a mean follow-up of 27.9 months. The mean hadron therapy (HT) dose was 60 ± 14 Gray, with a mean dose per fraction of 2.3 ± 2.1 Gray. Six patients were treated with carbon ions and 26 with protons. Pituitary hormone alteration of some kind was reported for six patients. No patient experienced unexpected severe adverse events related to particle therapy. Conclusion Particle radiotherapy performed on anterior skull base lesions has proved to cause limited damage to pituitary function in the adult population.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giada Todeschini
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
| | - Elisabetta Lovati
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Pietro Lucotti
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Daniele Bongetta
- Neurosurgery Unit, Ospedale Fatebenefratelli e Oftalmico, Azienda Socio Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Di Sabatino
- Internal Medicine Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Iacopo Cavallo
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Policlinico San Matteo, Pavia, Italy
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Wang S, Fu Z, Sun Y, Zhang M, Chen A, Cao C, Song J. Altered hemispheric asymmetry of attentional networks in patients with pituitary adenoma: an event-related potential study. Front Neurosci 2023; 17:1198409. [PMID: 37250398 PMCID: PMC10211341 DOI: 10.3389/fnins.2023.1198409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Emerging evidence has been reported of attentional dysfunction in pituitary adenoma patients. However, the effect of pituitary adenomas on lateralized attention network efficiency remained to be clear. Thus, the present study aimed to investigate the impairment of lateralized attention networks in patients with pituitary adenoma. Methods Eighteen pituitary adenoma patients (PA group) and 20 healthy controls (HCs) were included in this study. Both behavioral results and event-related potentials (ERPs) were acquired while subjects performed the Lateralized Attention Network Test (LANT). Results Behavioral performances indicated the PA group had a slower reaction time and a similar error rate relative to the HCs group. Meanwhile, significantly increased executive control network efficiency suggested the dysfunction of inhibition control in PA patients. Regarding ERP results, there were no group differences in the alerting and orienting networks. The target-related P3 was significantly reduced in the PA group, suggesting an impairment of executive control function and attentional resources allocation. Moreover, the mean amplitude of P3 was significantly lateralized to the right hemisphere, and interacted with the visual field, exhibiting that the right hemisphere dominated the bilateral visual field, whereas the left hemisphere dominated the left visual field. In the specific high-conflict condition, the pattern of hemispheric asymmetry in the PA group was altered due to a mixed effect resulting from the compensatory recruitment of attentional resources in the left central parietal area and the destructive effects of hyperprolactinemia. Conclusion These findings suggested that, in the lateralized condition, the decreased P3 in the right central parietal area and the diminished hemispheric asymmetry under high conflict load, may serve as the potential biomarkers of attentional dysfunction in patients with pituitary adenoma.
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Affiliation(s)
- Shuochen Wang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Neurosurgery, The General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Zhenghao Fu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Neurosurgery, The General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Yuanyi Sun
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Neurosurgery, The General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Meng Zhang
- Department of Neurosurgery, The General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Aobo Chen
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Chenglong Cao
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Jian Song
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Neurosurgery, The General Hospital of Central Theater Command, Wuhan, Hubei, China
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3
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Hyperprolactinemia Associated with Attentional Processing and Interference Control Impairments in Patients with Prolactinomas. Brain Sci 2022; 12:brainsci12081091. [PMID: 36009154 PMCID: PMC9406026 DOI: 10.3390/brainsci12081091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/25/2022] Open
Abstract
The cognitive impairment of pituitary adenomas (PAs) has received increasing attention. Hyperprolactinemia and tumor mass effect are the potential causes. The aim of this study was to identify possible cognitive impairment and to further explore the correlation between these indices and prolactin (PRL) levels, based on the control of tumor size. Twenty-seven patients with prolactinomas (patient group) and twenty-six matched health control group (HC group) were enrolled in this study. All participants performed the flanker task while we continuously recorded electroencephalography data. On the behavioral performance level, patients showed a significantly slower reaction time (RT) in both flanker types. Concerning the event-related potentials level, patients elicited reduced P2 and enhanced N2 amplitudes compared with the HC group, suggesting an impairment of attentional processing (P2) and conflict monitoring (N2). Moreover, the patient group also induced lower P3 amplitudes relative to the HC group in both types, indicating that there were deficits in attentional resource allocation ability. We also found a significant correlation between the P3 amplitudes and incongruent condition RTs, as well as the subsequent PRL levels in the patient group. In conclusion, this is an innovative study that reveals the impaired cognition abilities in prolactinomas, and also proposes the possible cognitive toxicity of oversecreted PRL levels, which provides evidence for further research on the cognitive decline in PAs.
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Song S, Wang L, Qi Q, Wang H, Feng L. Endoscopic vs. microscopic transsphenoidal surgery outcomes in 514 nonfunctioning pituitary adenoma cases. Neurosurg Rev 2022; 45:2375-2383. [PMID: 35230574 DOI: 10.1007/s10143-022-01732-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/19/2021] [Accepted: 01/05/2022] [Indexed: 12/22/2022]
Abstract
Transsphenoidal surgery remains the preference choice for patients with nonfunctioning pituitary tumors at present, but the superiority of surgical modalities is still debated. Moreover, the efficacy of microscopic and endoscopic transsphenoidal surgery has not been fully studied. Therefore, the present study was designed to compare the postoperative outcomes of the two widely used approaches worldwide. This retrospective study included 514 patients with the first transsphenoidal pituitary adenoma resection in Shandong Provincial Hospital from January 2015 to July 2020 and compared the outcomes of microscope transsphenoidal surgery (MTSS) and endoscopy transsphenoidal surgery (ETSS). A total of 514 patients were included in this study, of whom 210 received the ETSS and 304 received the MTSS. The patients in two groups were similar in terms of postoperative hyponatremia (p = 0.229), diabetes insipidus (p = 0.264), the recovery of hormonal axis (p < 0.05), and extent of resection (EOR) (p = 0.067). ETSS was more likely to cause cerebrospinal fluid leakage than MTSS (p = 0.017, 3.6% vs. 8.6%). CSF leakage might be related to tumor size (95% CI = 1.305-2.766, p = 0.001), and the surgeon's transsphenoidal surgery volume < 300 was also a risk factor (95% CI = 1.396-9.067, p = 0.008). The effect of different surgeries on postoperative vision improvement was statistically difference in univariate analysis (p = 0.048) but not after adjustment for confounders (p = 0.112). Furthermore, there were statistical difference in EOR between MTSS and ETSS when adenomas were performed suprasellar extension (p = 0.037) or optic chiasm compression (p = 0.045). Both techniques are valid for the treatment of nonfunctional adenomas. But CSF leakage is more likely after ETSS. In addition, ETSS is more conducive to resection of nonfunctional adenomas with suprasellar extension or optic chiasm compression.
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Affiliation(s)
- Shuaihua Song
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Linping Wang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Qianjin Qi
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Haoran Wang
- Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China
| | - Li Feng
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Brownlee N, Wilson C, Curran DB, Wright G, Flannery T, Caldwell SB. Cognitive and psychosocial outcomes following stereotactic radiosurgery for acoustic neuroma. NeuroRehabilitation 2021; 50:151-159. [PMID: 34957955 DOI: 10.3233/nre-210106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acoustic Neuroma (AN) is a benign tumour of the eighth cranial nerve. Stereotactic Radiosurgery (SRS) is a common treatment approach. Studies have explored the primary effects of SRS and documented equivalent efficacy for tumour control compared to neurosurgery. OBJECTIVE Examine the longer term cognitive and psychosocial outcomes of SRS in non-Neurofibromatosis Type II patients utilising both objective and subjective cognitive outcomes associated with quality of life and health related distress. METHODS Nineteen individuals treated via SRS were assessed using a battery of standardised psychometric tests as well as measures of quality of life and psychological distress. RESULTS Participants had largely preserved cognitive function except for processing speed, aspects of attention and visual memory relative to age norms. Self-reported quality of life was better than in other AN population studies. Level of psychological distress was equivalent to general population norms. More than half of participants reported subjective cognitive decline though this was not fully supported by objective testing. Subjective cognitive complaints may be associated with lower reported quality of life. CONCLUSIONS Results are largely consistent with previous findings on the effects of SRS in other clinical groups, which supports SRS as a targeted radiation treatment for AN.
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Affiliation(s)
| | - Colin Wilson
- Regional Acquired Brain Injury Unit (RABIU), Musgrave Park Hospital, Belfast, Northern Ireland
| | - David B Curran
- Clinical Psychology Department, David KeirBuilding, Queen's University Belfast, Belfast, Northern Ireland
| | - Gavin Wright
- Medical Physics and Engineering Department, St.James's University Hospital, Leeds, UK
| | - Tom Flannery
- Departmentof Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Sheena B Caldwell
- Regional Acquired Brain Injury Unit (RABIU), Belfast, Northern Ireland
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6
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Zarino B, Verrua E, Ferrante E, Sala E, Carosi G, Giavoli C, Serban AL, Del Sindaco G, Sirtori MA, Bertani GA, Rampini P, Carrabba GG, Arosio M, Spada A, Locatelli M, Mantovani G. Cushing's disease: a prospective case-control study of health-related quality of life and cognitive status before and after surgery. J Neurosurg 2020; 133:1721-1731. [PMID: 31731265 DOI: 10.3171/2019.8.jns19930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Some studies have highlighted psychological and neuropsychological difficulties and a potential reduction in health-related quality of life (HRQOL) in patients with pituitary tumors, despite hormone deficits or excess. To the authors' knowledge, this study is the first prospective longitudinal case-control study with the aim of simultaneously testing whether HRQOL and psychiatric and neuropsychological disabilities are related to neural dysfunction due to hypercortisolism per se, or tumor mass and/or surgery in patients with Cushing's disease (CD). The authors evaluated a homogeneous cohort of patients with CD and nonfunctioning pituitary adenomas (NFPAs) before and after neurosurgery and compared these patients with healthy controls. METHODS Twenty patients (10 with NFPA and 10 with CD) were evaluated using 3 validated questionnaires (SF-36, Beck Depression Inventory-II [BDI-II], and Minnesota Multiphasic Personality Inventory-II [MMPI-II]) to assess HRQOL and psychological status preoperatively and 12 months after neurosurgery. Neuropsychological tests were assessed preoperatively, 3-7 days postoperatively, and 12 months postoperatively. Twenty healthy matched controls were recruited. RESULTS Preoperatively, the NFPA and CD subgroups had worse HRQOL scores than controls on the basis of SF-36 scores, although the NFPA subgroup experienced significant recovery 12 months postoperatively. Preoperatively, CD patients had depressive symptoms according to the BDI-II and MMPI-II that persisted 12 months postoperatively, together with social introversion and hypochondriasis; NFPA patients were similar to controls except for hypochondriasis scores that were clinically significant at all timepoints. Preoperatively and 3-7 days postoperatively, both subgroups showed significant neuropsychological disabilities compared with controls, but only the CD subgroup did not completely recover over time. CONCLUSIONS HRQOL and neuropsychological impairments were observed in all patients at early timepoints, independent of hypercortisolism, tumor mass, and successful surgery. Over time, CD patients showed persistent changes in HRQOL, in particular in social activities. In this light, CD seems to have a strong impact on HRQOL and to be associated with more psychological and neuropsychological comorbidities than NFPA.
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Affiliation(s)
| | - Elisa Verrua
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Emanuele Ferrante
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Elisa Sala
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Giulia Carosi
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Claudia Giavoli
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Andreea L Serban
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- 6Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Giulia Del Sindaco
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Martina A Sirtori
- 1Neurosurgery Unit and
- 5Department of Psychology, University of Milano-Bicocca, Milan; and
| | | | | | | | - Maura Arosio
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Anna Spada
- Departments of3Clinical Sciences and Community Health, and
| | - Marco Locatelli
- 1Neurosurgery Unit and
- 4Pathophysiology and Transplantation, University of Milan
| | - Giovanna Mantovani
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
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Cao C, Wen W, Liu B, Ma P, Li S, Xu G, Song J. Theta oscillations in prolactinomas: Neurocognitive deficits in executive controls. Neuroimage Clin 2020; 28:102455. [PMID: 33038668 PMCID: PMC7554198 DOI: 10.1016/j.nicl.2020.102455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023]
Abstract
Impairment of cognitive functions has been reported in prolactinomas. However, the electrophysiological mechanisms of response activation and response inhibition in prolactinomas remain unclear. We recorded participants' scalp electroencephalography (EEG) in a visual Go/Nogo task. Compared to the healthy controls (HCs), the patients demonstrated worse performance and their prolactin (PRL) levels negatively correlated with behavioral results. Meanwhile, patients' P300 amplitudes in the Go and Nogo conditions were smaller than the HCs. The amplitudes of N200nogo in patients were smaller than the HCs as well. Lower frontal theta power was found in the patients than the HCs in both Go and Nogo conditions, which indicated a deficit in response activation and inhibition. Moreover, the PRL levels mediated the relationship between frontal theta power and behavior performance, implying that lower frontal theta power caused the dysfunction of response control by abnormally high PRL levels. Patients also showed lower occipital alpha power than the HCs, which suggested that the impaired response inhibition may arise from deficient attention control. Taken together, the present study revealed the neurocognitive discrepancies between prolactinomas and the HCs. The frontal theta oscillation was highlighted as the electrophysiological markers of the impaired response control in prolactinomas.
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Affiliation(s)
- Chenglong Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430070, China
| | - Wen Wen
- School of Psychological and Cognitive Sciences, Peking University, Beijing 100871, China
| | - Binbin Liu
- Wuhan University of Science and Technology, Wuhan 430000, China
| | - Pan Ma
- Wuhan Children's Hospital, Tongji Medical College of Huazhong University of Science & Technology, China
| | - Sheng Li
- School of Psychological and Cognitive Sciences, Peking University, Beijing 100871, China
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China; Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430070, China.
| | - Jian Song
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430070, China.
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8
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Butterbrod E, Gehring K, Voormolen EH, Depauw PRAM, Nieuwlaat WA, Rutten GJM, Sitskoorn MM. Cognitive functioning in patients with nonfunctioning pituitary adenoma before and after endoscopic endonasal transsphenoidal surgery. J Neurosurg 2020; 133:709-716. [PMID: 31443073 DOI: 10.3171/2019.5.jns19595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with nonfunctioning pituitary adenomas (NFPAs) can suffer from cognitive dysfunction. However, the literature on longitudinal cognitive follow-up of patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) is limited. This study was performed to investigate perioperative cognitive status and course in patients with NFPAs. METHODS Patients underwent computerized neuropsychological assessment 1 day before (n = 45) and 3 months after (n = 36) EETS. Performance in 7 domains was measured with a computerized test battery (CNS Vital Signs) and standardized using data from a healthy control group. The authors conducted analyses of cognitive performance at both time points and changes pre- to post-ETSS on a group and an individual level. Linear multiple regression analyses were employed to investigate predictors of cognitive performance. RESULTS On average, patients scored significantly lower in 6 of 7 cognitive domains before and after surgery than controls. Impairment proportions were significantly higher among patients (56% before surgery, 63% after surgery) than among controls. Patients showed no change over time in group-level (mean) performance, but 28% of individual patients exhibited cognitive improvement and 28% exhibited cognitive decline after surgery. Hormonal deficiency showed a positive correlation with verbal memory before surgery. Postoperative performances in all cognitive domains were predicted by preoperative performances. CONCLUSIONS Cognitive impairment was present before and after EETS in over half of NFPA patients. Individual patients showed diverse postoperative cognitive courses. Monitoring of cognitive functioning in clinical trajectories and further identification of disease-related and psychological predictors of cognition are warranted.
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Affiliation(s)
- Elke Butterbrod
- 1Department of Cognitive Neuropsychology, Tilburg University; and
| | - Karin Gehring
- 1Department of Cognitive Neuropsychology, Tilburg University; and
- 2Departments of Neurosurgery and
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9
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Marsh L, Guinan E, Shah E, Powell M, Lowy C, Kopelman MD. A prospective study of the cognitive and psychiatric effects of pituitary tumours and their treatments. J Clin Neurosci 2020; 75:122-127. [PMID: 32199742 DOI: 10.1016/j.jocn.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 01/16/2020] [Accepted: 03/08/2020] [Indexed: 11/15/2022]
Abstract
Neurocognitive complaints are common in patients with pituitary tumours, particularly in memory and concentration. Past studies have shown impairments in executive function and memory, but it is not clear whether these result from direct effects of the tumour (pressure or hormonal secretion), incidental damage from radiotherapy or surgical treatments, and/or mediating psychiatric factors. This study assessed cognitive function and psychiatric state of 86 pituitary tumour patients and 18 healthy controls, pre and post-treatment, to examine the effects of tumour aetiology and treatment type. No significant cognitive impairments were found, except on verbal recognition memory. Patients with Cushing's disease showed lower verbal recognition memory than the other groups pre-treatment, but improved at follow-up. This was (at least partially) accounted for by an improvement in depression scores. Patients who were treated with surgery showed poorer verbal recognition memory than controls across all (pre- and post-treatment) time-points. Overall findings of minimal cognitive impairment in patients with pituitary tumours may reflect improved diagnostic and treatment techniques in recent years. We suggest that the verbal memory impairments identified in the Cushing's group may result from increased cortisol (directly, or mediated by depression). In the surgical groups, verbal memory impairments appeared to pre-date treatment. This may relate to treatment selection factors, rather than harmful effects of surgery itself.
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Affiliation(s)
- Laura Marsh
- King's College London, Based at St Thomas's Hospital, London SE1 7EH, United Kingdom
| | - Elizabeth Guinan
- King's College London, Based at St Thomas's Hospital, London SE1 7EH, United Kingdom
| | - Emily Shah
- King's College London, Based at St Thomas's Hospital, London SE1 7EH, United Kingdom
| | - Michael Powell
- National Hospital for Neurology and Neurosurgery, London WC1, United Kingdom
| | - Clara Lowy
- King's College London, Based at St Thomas's Hospital, London SE1 7EH, United Kingdom; Guy's and St Thomas's NHS Foundation Trust, United Kingdom
| | - Michael D Kopelman
- King's College London, Based at St Thomas's Hospital, London SE1 7EH, United Kingdom
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10
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Kan W, Wang R, Yang K, Liu H, Zou Y, Liu Y, Zhao J, Luo Z, Chen J. Effect of Hormone Levels and Aging on Cognitive Function of Patients with Pituitary Adenomas Prior to Medical Treatment. World Neurosurg 2019; 128:e252-e260. [PMID: 31026659 DOI: 10.1016/j.wneu.2019.04.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairments have been reported in patients with pituitary adenomas (PAs). The aim of this research was to demonstrate the effects of hormones and age on cognitive decline in patients with PAs. METHODS A total of 64 patients with PA and 69 healthy control subjects (HCs) were recruited for this study. Both PAs and HCs were divided into a younger group (<50 years of age) and an older group (≥50 years of age). Neurocognitive domains were assessed using the Wechsler Adult Intelligence Scale-Chinese Revision (WAIS-RC) and Wechsler Memory Scale-Chinese Revision (WMS-RC) tests. Furthermore, we also investigated the relationship between cognitive domains and tumor volume, and the hormone levels and age of patients with PA. RESULTS Several of the cognitive impairments found on the WAIS-RC and WMS-RC tests were more frequently observed in untreated patients with PA. Importantly, no significant correlations were found between cognitive domains and tumor volume after controlling age, sex, and educational levels. Furthermore, several significant correlations were found between cognitive domains and hormone levels, such as free thyroxine and adrenocorticotropic hormone, after controlling age, sex, and educational levels. Finally, the age of the patients was found to correlate with a decrease in memory after controlling sex and educational levels. CONCLUSIONS Our findings demonstrate a significant decline in the cognitive performance of patients with PA prior to medical treatment, especially in older patients, which suggests that hormones and age have the ability to interact and aggravate cognitive decline in patients with PA.
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Affiliation(s)
- Wenwu Kan
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Wang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kun Yang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hongyi Liu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanjie Zou
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yong Liu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jinbing Zhao
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhengxiang Luo
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, Jiangsu, China; Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Fourth Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
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11
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Abstract
Radiation therapy (RT) is an effective treatment for patients with either nonfunctioning or secreting pituitary adenomas unsuccessfully treated by surgery and/or medical therapy, resulting in local control of 90-95% at 5-10 years and variable normalization of hormonal hypersecretion for patients with GH-, ACTH-, and prolactin-secreting adenomas in the range of 40-80% at 5 years; however, its use has been limited because of concerns regarding potential late toxicity of radiation and delayed efficacy in normalization of hormone hypersecretion. In the last decades, there have been advances in all aspects of radiation treatment, including more accurate immobilization, imaging, treatment planning and dose delivery. RT has evolved with the development of highly conformal stereotactic techniques and new planning and dose delivery techniques, including intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). All these new techniques allow precise and sharply focused radiation delivery reducing the dose to surrounding critical neurovascular and brain structures, and potentially limiting the long-term consequences of radiation treatments. In this review, we present a critical analysis of the more recent available literature on the use of RT in patients with both nonfunctioning and secreting pituitary adenomas, focussing particularly on the risk/benefit ratio of modern radiation techniques.
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Affiliation(s)
- Giuseppe Minniti
- Radiation Unit, UPMC Hillman Cancer Center, San Pietro Hospital, Rome, Italy.
| | - John Flickinger
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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The impact of transsphenoidal surgery on neurocognitive function: A systematic review. J Clin Neurosci 2017; 42:1-6. [DOI: 10.1016/j.jocn.2017.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
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Cognitive function surrounding resection of nonfunctioning pituitary adenomas with suprasellar extension: A prospective matched-control study. J Clin Neurosci 2017; 40:109-114. [DOI: 10.1016/j.jocn.2017.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/10/2017] [Indexed: 11/20/2022]
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Uto M, Mizowaki T, Ogura K, Miyabe Y, Nakamura M, Mukumoto N, Hirashima H, Hiraoka M. Volumetric modulated Dynamic WaveArc therapy reduces the dose to the hippocampus in patients with pituitary adenomas and craniopharyngiomas. Pract Radiat Oncol 2017; 7:382-387. [PMID: 28666908 DOI: 10.1016/j.prro.2017.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/26/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Reducing the radiation dose to the hippocampus is important to preserve cognitive function in patients with brain tumors. The Vero4DRT system can realize a new irradiation technique, termed volumetric-modulated Dynamic WaveArc therapy (VMDWAT), which allows the safe use of sequential noncoplanar volumetric-modulated beams without couch rotation. Because VMDWAT appears to reduce the hippocampal dose in patients with pituitary adenomas and craniopharyngiomas, we performed a planning study to compare the dose distribution of volumetric-modulated arc therapy using only a coplanar arc (coVMAT) and VMDWAT. METHODS AND MATERIALS CoVMAT and VMDWAT plans were created for 30 patients with pituitary adenomas and craniopharyngiomas. The prescription dose was 52.2 Gy in 29 fractions, with 99% of each planning target volume covered by 90% of the prescribed dose. Optimization was performed for maximal reduction of the dose to the hippocampus. Treatment time was defined as the beam-on time. RESULTS The mean equivalent dose in 2 Gy fractions to 40% of the volume of the bilateral hippocampus (EQD40%) for coVMAT/VMDWAT were 9.90/5.31 Gy, respectively (P < .001). The mean EQD40% in VMDWAT was less than 7.3 Gy, which is the threshold for predicting cognitive impairment. Although the volume of normal brain receiving 5 Gy (V5) was significantly larger in VMDWAT, compared with coVMAT, the normal brain volume receiving 10, 15, 20, 25, 30, 35, 40, 45, and 50 Gy (V10-50) was significantly smaller in VMDWAT. The conformity and homogeneity indices were significantly better in VMDWAT. The mean VMDWAT treatment time was longer compared with coVMAT (70.1 vs 67.1 seconds, respectively). CONCLUSIONS Although VMDWAT increased brain V5 and the treatment time compared with coVMAT, it significantly reduced the dose to the hippocampus and brain V10 to V50 and improved target conformity and homogeneity. VMDWAT could be a promising treatment technique for pituitary adenomas and craniopharyngiomas.
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Affiliation(s)
- Megumi Uto
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan.
| | - Kengo Ogura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yuki Miyabe
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Vieira Neto L, Boguszewski CL, Araújo LAD, Bronstein MD, Miranda PAC, Musolino NRDC, Naves LA, Vilar L, Ribeiro-Oliveira Júnior A, Gadelha MR. A review on the diagnosis and treatment of patients with clinically nonfunctioning pituitary adenoma by the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:374-90. [PMID: 27533614 PMCID: PMC10118716 DOI: 10.1590/2359-3997000000179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 04/22/2023]
Abstract
Clinically nonfunctioning pituitary adenomas (NFPA) are the most common pituitary tumors after prolactinomas. The absence of clinical symptoms of hormonal hypersecretion can contribute to the late diagnosis of the disease. Thus, the majority of patients seek medical attention for signs and symptoms resulting from mass effect, such as neuro-ophthalmologic symptoms and hypopituitarism. Other presentations include pituitary apoplexy or an incidental finding on imaging studies. Mass effect and hypopituitarism impose high morbidity and mortality. However, early diagnosis and effective treatment minimizes morbidity and mortality. In this publication, the goal of the Neuroendocrinology Department of the Brazilian Society of Endocrinology and Metabolism is to provide a review of the diagnosis and treatment of patients with NFPA, emphasizing that the treatment should be performed in reference centers. This review is based on data published in the literature and the authors' experience. Arch Endocrinol Metab. 2016;60(4):374-90.
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Affiliation(s)
- Leonardo Vieira Neto
- Universidade Federal do Rio de Janeiro, Brasil; Hospital Federal da Lagoa, Brasil
| | | | | | | | | | | | | | | | | | - Mônica R. Gadelha
- Universidade Federal do Rio de Janeiro, Brasil; Instituto Estadual do Cérebro Paulo Niemeyer, Brasil
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16
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Post-surgical management of non-functioning pituitary adenoma. ANNALES D'ENDOCRINOLOGIE 2015; 76:228-38. [PMID: 26116412 DOI: 10.1016/j.ando.2015.04.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 01/17/2023]
Abstract
Post-surgical surveillance of non-functioning pituitary adenoma (NFPA) is based on magnetic resonance imaging (MRI) at 3 or 6 months then 1 year. When there is no adenomatous residue, annual surveillance is recommended for 5 years and then at 7, 10 and 15 years. In case of residue or doubtful MRI, prolonged annual surveillance monitors any progression. Reintervention is indicated if complete residue resection is feasible, or for symptomatic optic pathway compression, to create a safety margin between the tumor and the optic pathways ahead of complementary radiation therapy (RT), or in case of post-RT progression. In case of residue, unless the tumor displays elevated growth potential, it is usually recommended to postpone RT until progression is manifest, as efficacy is comparable whether treatment is immediate or postponed. The efficacy of the various RT techniques in terms of tumor volume control is likewise comparable. RT-induced hypopituitarism is frequent, whatever the technique. The choice thus depends basically on residue characteristics: size, delineation, and proximity to neighboring radiation-sensitive structures. Reduced rates of vascular complications and secondary brain tumor can be hoped for with one-dose or hypofractionated stereotactic RT, but there has been insufficient follow-up to provide evidence. Somatostatin analogs and dopaminergic agonists have yet to demonstrate sufficient efficacy. Temozolomide is an option in aggressive NFPA resistant to surgery and RT.
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Yang CJ, Huang GS, Xiao FR, Lou MF. Symptom distress and quality of life after stereotactic radiosurgery in patients with pituitary tumors: a questionnaire survey. PLoS One 2014; 9:e88460. [PMID: 24505492 PMCID: PMC3914988 DOI: 10.1371/journal.pone.0088460] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) is a common treatment for recurrent or residual pituitary adenomas. The persistence of symptoms and treatment related complications may impair the patient’s quality of life (QOL). Purpose The purpose of this study was to examine symptom distress, QOL, and the relationship between them among patients with pituitary tumors who had undergone SRS. Methods This study used a cross-sectional design and purposive sampling. We enrolled patients diagnosed with pituitary tumors who had undergone SRS. Data were collected at the CyberKnife Center at a medical center in Northern Taiwan in 2012. A questionnaire survey was used for data collection. Our questionnaire consisted of 3 parts the Pituitary Tumor Symptom Distress Questionnaire, the World Health Organization Quality of Life Instrument Short-Form (WHOQOL-BREF), and a demographic questionnaire. Results Sixty patients were enrolled in the study. The most common symptoms reported by patients after SRS were memory loss, fatigue, blurred vision, headache, sleep problems, and altered libido. The highest and lowest scores for QOL were in the environmental and psychological domains, respectively. Age was positively correlated with general health and the psychological domains. Level of symptom distress was negatively correlated with overall QOL, general health, physical health, and the psychological and social relationships domains. The scores in the psychological and environmental domains were higher in males than in females. Patients with ≤6 symptoms had better overall QOL, general health, physical health, and psychological and social relationships than those with >6 symptoms. Conclusion Symptom distress can affect different aspects of patient QOL. Levels of symptom distress, number of symptoms, age, and gender were variables significantly correlated with patient QOL. These results may be utilized by healthcare personnel to design educational and targeted interventional programs for symptom management to improve patient QOL.
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Affiliation(s)
- Ching-Ju Yang
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Guey-Shiun Huang
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fu-Ren Xiao
- Division of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Meei-Fang Lou
- Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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18
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[Cushing's disease with negative imaging in adults]. ANNALES D'ENDOCRINOLOGIE 2013; 74 Suppl 1:S23-32. [PMID: 24356288 DOI: 10.1016/s0003-4266(13)70018-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 12/12/2012] [Accepted: 12/28/2013] [Indexed: 11/20/2022]
Abstract
In more than one third of patients with Cushing's disease, pituitary MRI does not identify a microadenoma. The diagnostic approach should be as rigorous as possible in patients with ACTH-dependent Cushing's syndrome, to obtain a definitive diagnosis. Improved pituitary MRI techniques, including dynamic sequences, optimal T1-weighted spin-echo MRI protocol, MRI technique of spoiled gradient recalled acquisition in the steady state, and using a 3-tesla magnet, improved the tumor detection rate, parallel to the performance of endocrine dynamic tests (CRH stimulation, desmopressin stimulation and high-dose dexamethasone suppression tests). When a pituitary tumor is not convincingly identified, inferior petrosal sinus sampling remains the gold standard for diagnosis, and recently, new approaches (simultaneous prolactin measurement) could improve its sensitivity and specificity. Transsphenoidal surgery is the first-line treatment, with remission rates similar to those of patients with preoperative positive MRI. However, medical therapies play an important role after surgical failure or in a search for the onset of a visible tumor, especially with development of new drugs targeting the pituitary gland.
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Shen C, Xie R, Cao X, Bao W, Yang B, Mao Y, Gao C. Intelligence deficits in Chinese patients with brain tumor: the impact of tumor resection. ScientificWorldJournal 2013; 2013:261236. [PMID: 24288472 PMCID: PMC3832967 DOI: 10.1155/2013/261236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intelligence is much important for brain tumor patients after their operation, while the reports about surgical related intelligence deficits are not frequent. It is not only theoretically important but also meaningful for clinical practice. METHODS Wechsler Adult Intelligence Scale was employed to evaluate the intelligence of 103 patients with intracranial tumor and to compare the intelligence quotient (IQ), verbal IQ (VIQ), and performance IQ (PIQ) between the intracerebral and extracerebral subgroups. RESULTS Although preoperative intelligence deficits appeared in all subgroups, IQ, VIQ, and PIQ were not found to have any significant difference between the intracerebral and extracerebral subgroups, but with VIQ lower than PIQ in all the subgroups. An immediate postoperative follow-up demonstrated a decline of IQ and PIQ in the extracerebral subgroup, but an improvement of VIQ in the right intracerebral subgroup. Pituitary adenoma resection exerted no effect on intelligence. In addition, age, years of education, and tumor size were found to play important roles. CONCLUSIONS Brain tumors will impair IQ, VIQ, and PIQ. The extracerebral tumor resection can deteriorate IQ and PIQ. However, right intracerebral tumor resection is beneficial to VIQ, and transsphenoidal pituitary adenoma resection performs no effect on intelligence.
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Affiliation(s)
- Chao Shen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Rong Xie
- Institute of Neurology, Fudan University, Shanghai 200040, China
| | - Xiaoyun Cao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Weimin Bao
- Institute of Neurology, Fudan University, Shanghai 200040, China
| | - Bojie Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chao Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Neurocognitive Changes in Pituitary Adenoma Patients After Fractionated External Beam Radiotherapy Versus Gamma Knife Radiosurgery. World Neurosurg 2012; 78:53-7. [DOI: 10.1016/j.wneu.2011.12.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 12/09/2011] [Indexed: 11/21/2022]
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21
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Tooze A, Hiles CL, Sheehan JP. Neurocognitive Changes in Pituitary Adenoma Patients After Gamma Knife Radiosurgery: A Preliminary Study. World Neurosurg 2012; 78:122-8. [DOI: 10.1016/j.wneu.2011.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 09/03/2011] [Indexed: 11/24/2022]
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22
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Minniti G, Scaringi C, Enrici RM. Radiation techniques for acromegaly. Radiat Oncol 2011; 6:167. [PMID: 22136376 PMCID: PMC3275813 DOI: 10.1186/1748-717x-6-167] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 12/02/2011] [Indexed: 11/28/2022] Open
Abstract
Radiotherapy (RT) remains an effective treatment in patients with acromegaly refractory to medical and/or surgical interventions, with durable tumor control and biochemical remission; however, there are still concerns about delayed biochemical effect and potential late toxicity of radiation treatment, especially high rates of hypopituitarism. Stereotactic radiotherapy has been developed as a more accurate technique of irradiation with more precise tumour localization and consequently a reduction in the volume of normal tissue, particularly the brain, irradiated to high radiation doses. Radiation can be delivered in a single fraction by stereotactic radiosurgery (SRS) or as fractionated stereotactic radiotherapy (FSRT) in which smaller doses are delivered over 5-6 weeks in 25-30 treatments. A review of the recent literature suggests that pituitary irradiation is an effective treatment for acromegaly. Stereotactic techniques for GH-secreting pituitary tumors are discussed with the aim to define the efficacy and potential adverse effects of each of these techniques.
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Affiliation(s)
- Giuseppe Minniti
- Department of Neuroscience, Neuromed Institute, Pozzilli, IS, Italy.
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Psaras T, Milian M, Hattermann V, Gerlach C, Honegger J. Executive functions recover earlier than episodic memory after microsurgical transsphenoidal resection of pituitary tumors in adult patients--a longitudinal study. J Clin Neurosci 2011; 18:1340-5. [PMID: 21782447 DOI: 10.1016/j.jocn.2011.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 01/08/2011] [Accepted: 01/16/2011] [Indexed: 11/16/2022]
Abstract
Pituitary tumors may lead to cognitive dysfunction, and the most prevalent deficits are impaired memory and attention. To investigate whether memory and executive functions improve after surgical treatment we performed a prospective longitudinal study comprising 106 patients with pituitary tumors. Psychometric evaluation was performed with the d2-Letter Cancellation test, the Trail Making test, the Digit Span test and the Intelligence Structure test-Verbal Memory test at three timepoints: preoperatively, and at 3 months and 12 months after surgery. The preoperative and postoperative maximum suprasellar tumor extension and hormone status was assessed in all participants. The main finding was that concentration, working memory, and attentional speed improved significantly within the first 3 months after surgery (p<0.05), while improvement of episodic memory was not observed until 12 months after surgery (p<0.001). In the patients harbouring non-functioning adenomas, prolactinomas or other sellar lesions, the most important factor promoting improvement of neurocognitive function was the removal of the suprasellar tumor extension.
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Affiliation(s)
- T Psaras
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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Wong GKC, Wong R, Poon WS. Cognitive Outcomes and Activity of Daily Living for Neurosurgical Patients with Intrinsic Brain Lesions: A 1-year Prevalence Study. Hong Kong J Occup Ther 2011. [DOI: 10.1016/j.hkjot.2011.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background No prevalence data on cognitive outcomes are available for general neurosurgical patients and few studies have assessed the correlation between common cognitive assessment tools of the occupational therapists and activity of daily living (ADL) at 1 year. Methods Consecutive neurosurgical patients with intrinsic brain lesions (brain tumours, traumatic intracerebral haematomas, spontaneous intracerebral haematomas, and cerebral arteriovenous malformations) were approached for consent to participate in the present study. Results At 1 year, the Montreal Cognitive Assessment score (mean ± standard deviation) was 20.4 (±8.6) and 42% of the patients had scores less than 22. The median number of the Neurobehavioral Cognitive Status Examination domains below the cutoff values was 8 (interquartile range: 3.5–9.75). Conclusions The cognitive assessments–-the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Rivermead Behavioural Memory Test–-showed satisfactory discriminating power for complete independence in instrumental ADL. Instrumental ADL was best correlated with the Rivermead Behavioural Memory Test.
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Affiliation(s)
- George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rosanna Wong
- Department of Occupational Therapy, Prince of Wales Hospital, Shatin, Hong Kong
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Brummelman P, Elderson MF, Dullaart RPF, van den Bergh ACM, Timmer CA, van den Berg G, Koerts J, Tucha O, Wolffenbuttel BHR, van Beek AP. Cognitive functioning in patients treated for nonfunctioning pituitary macroadenoma and the effects of pituitary radiotherapy. Clin Endocrinol (Oxf) 2011; 74:481-7. [PMID: 21133979 DOI: 10.1111/j.1365-2265.2010.03947.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT AND OBJECTIVE Cognitive deterioration is reported in patients with a nonfunctioning pituitary macroadenoma (NFA) and after pituitary radiotherapy. However, reported results are inconsistent and are potentially confounded by different underlying pituitary disorders. The aim of this study was to examine cognitive functions in patients previously treated for NFA with or without radiotherapy. DESIGN Verbal memory was assessed with the Dutch equivalent to the Rey Auditory Verbal Learning Test (15 Words Test, 15 WT). Executive functioning was examined using the Ruff Figural Fluency Test (RFFT). We compared our patient cohort with large reference populations representative of the Dutch population. PATIENTS Eighty-four patients (62±10 years) who underwent transsphenoidal surgery 8.6±6.3 years earlier participated. Patients who underwent radiotherapy (n=39) were compared to those who received surgery alone (n=45). All patients were on stable hormonal replacement therapy. RESULTS The total patient group scored significantly below the reference sample on all 15 WT z-scores (95%CI): short-term memory, -0.3 (-0.5 to -0.1); total memory, -0.8 (-1.1 to -0.5); learning score, -0.3 (-0.5 to -0.1); delayed memory, -0.8 (-1.1 to -0.5), all P<0.01. The total patient group scored significantly below the reference sample on RFFT z-scores (95%CI): unique designs, -0.7 (-0.9 to -0.5) and perseverative errors, -0.5 (-0.8 to -0.2), both P<0.001. Patients who underwent radiotherapy showed no significant differences on cognition when compared to those who received surgery alone. CONCLUSION Patients with NFA score significantly worse on cognition compared to reference populations. Radiotherapy does not appear to have a major influence on cognition.
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Affiliation(s)
- Pauline Brummelman
- Department of Endocrinology, University Medical Center Groningen, The Netherlands.
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Deteriorated executive functions in patients with successful surgery for pituitary adenomas compared with other chronically ill patients. J Int Neuropsychol Soc 2011; 17:369-75. [PMID: 21205414 DOI: 10.1017/s1355617710001645] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pituitary adenomas, even after successful treatment, are associated with cognitive impairments. It is unclear whether these deficits are a consequence of unspecific factors associated with having a chronic illness and whether the cognitive dysfunctions exceed those of other chronically ill patients. Thirty-eight patients with transsphenoidal surgery for pituitary adenomas and 38 patients undergoing L-thyroxine replacement therapy after thyroid surgery were studied neuropsychologically with established tests. Executive function was examined with the Trail-Making Test A and B, working memory with the digit span test, attention with the digit symbol test, verbal memory with the German version of the Auditory Verbal Learning and Memory Test, and general verbal intelligence by a vocabulary test. Attention (p = .007), attentional speed (p = .0004), executive control (p = .04), and working memory (p = .01), were significantly reduced in patients with pituitary adenomas compared with other chronically ill patients. In contrast, no differences were found between the groups for verbal memory (all subtests: p ≥ .06). Patients with successful surgery for pituitary adenomas show also in comparison with other chronically ill patients an increased risk for deficits in certain aspects of cognitive function, including attention and working memory, supporting the relevance of the brain lesion and its treatment for these dysfunctions.
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Kasuki Jomori de Pinho L, Vieira Neto L, Armondi Wildemberg LE, Gasparetto EL, Marcondes J, de Almeida Nunes B, Takiya CM, Gadelha MR. Low aryl hydrocarbon receptor-interacting protein expression is a better marker of invasiveness in somatotropinomas than Ki-67 and p53. Neuroendocrinology 2011; 94:39-48. [PMID: 21178332 DOI: 10.1159/000322787] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/10/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Some pituitary adenomas exhibit fast growth and invade surrounding structures. To date, there is no robust marker to predict invasiveness. AIM To evaluate Ki-67, p53 and aryl hydrocarbon receptor-interacting protein (AIP) expression and compare these between invasive and noninvasive somatotropinomas and nonfunctioning pituitary adenomas (NFPAs). METHODS Protein expression was determined by immunohistochemistry. Tumors were classified according to percentage of immunolabeled nuclei for Ki-67 and p53. AIP immunopositivity was graded according to a score encompassing pattern and intensity. Invasiveness was defined according to radiological and surgical criteria. RESULTS Thirty-eight sporadic somatotropinomas were studied. Median Ki-67 labeling index in invasive and noninvasive tumors was 1.6 (range 0-20.6) and 0.26 (0-2.2), respectively (p = 0.01). With a 2.3% cut-off point obtained by ROC curve analysis, invasive adenomas were distinguished with 100% specificity, 39% sensitivity, and 63% accuracy. Low AIP expression was also correlated with tumor invasiveness (p = 0.001), with sensitivity, specificity and accuracy of 78, 80, and 79%, respectively. Expression of p53 was not different among tumors. Twenty-nine NFPAs were studied, with no significant difference between Ki-67, p53 and AIP expression in invasive and noninvasive tumors. High AIP expression was more frequent in NFPAs, with Ki-67 >3% (p = 0.051), especially when only gonadotrope cell adenomas (n = 25) were considered (p = 0.012). CONCLUSIONS These data suggest, for the first time, that AIP is a better marker of invasiveness in somatotropinomas than Ki-67 and p53. In addition, low AIP expression is observed in invasive somatotropinomas, in contrast with high AIP expression in NFPAs (mainly gonadotrope cell tumors) with high proliferative indices.
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Abstract
There has been growing interest in the psychosocial aspects of Cushing's syndrome, such as the role of life stress as a pathogenetic factor, the association with affective disorders, and the presence of residual symptoms after treatment. Interestingly, a temporal relationship between stressful life events and disease onset is relevant only to pituitary-dependent Cushing's disease, and not to the pituitary-independent forms. A number of psychiatric and psychological disturbances may be associated with the active hypercortisolemic state, regardless of its etiology. Within the high frequency of mood disorders (about 60%), major depression is the most common complication. Other psychopathological aspects include mania, anxiety disorders, psychological symptoms (demoralization, irritable mood, somatization) and cognitive impairment. Cognitive symptoms are associated with brain abnormalities (mainly loss of brain volume). Quality of life may be seriously compromised during both active and post-treatment phases. Long-standing hypercortisolism may imply a degree of irreversibility of the pathological process. Recovery, thus, may be delayed and be influenced by highly individualized affective responses. Outcomes of Cushing's syndrome treatment are not fully satisfactory. Within its great complexity, a conceptual shift from a merely biomedical care to a psychosomatic consideration of the person and his/her quality of life appears to be necessary to improve effectiveness. It is time to translate the research evidence that has accumulated into clinical practice initiatives. To patients who show persistence or even worsening of psychological distress upon adequate endocrine treatment psychiatric/psychological interventions should be readily available. Applying interdisciplinary expertise and addressing the needs for rehabilitation would markedly improve final outcome.
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Affiliation(s)
- Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Via Battisti 241, 35121 Padova, Italy.
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