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Imran SA, Wilkinson M. Cognition and psychological wellbeing in hypopituitary patients. Rev Endocr Metab Disord 2024; 25:505-512. [PMID: 38146042 DOI: 10.1007/s11154-023-09869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 12/27/2023]
Abstract
Hypopituitarism (HP) frequently occurs in patients presenting with sellar masses and despite recent advances in therapeutic options, HP patients consistently suffer from impaired quality of life due to psychological distress and cognitive dysfunction. These neurocognitive complications tend to persist in spite of surgical or biochemical remission of the disease making it especially challenging to segregate the effect of HP per se from other comorbidities such as the effect of tumour, surgery, radiation therapy, or complications caused by excess hormone production. Regardless, there is ample evidence to suggest that receptors for various pituitary hormones are abundantly expressed in key areas of central nervous system that are associated with memory and behaviour function and HP is also associated with poor sleep which can further exacerbate neurocognitive dysfunction. There is also evidence that hormonal replacement in HP patients partially restores these neurocognitive functions and improves sleep disorders. However, there is a need for creating better awareness among healthcare providers interacting with HP patients to enhance an earlier recognition of these disorder and their impact on quality of life despite initial remission. Importantly, there is a need to not only develop better and more cost-effective replacement therapies that would closely mimic the physiological hormonal release patterns, but also develop coping strategies for HP patients suffering from these complications.
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Affiliation(s)
- Syed Ali Imran
- Division of Endocrinology, Dalhousie University, Room 047, 7th Floor, North Victoria Building 1276 South Park Street, Halifax, NS, B3h 2Y9, Canada.
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de Villiers O, Elliot-Wilson C, Thomas KGF, Semple PL, Naiker T, Henry M, Ross IL. Sleep and cognition in South African patients with non-functioning pituitary adenomas. PLoS One 2024; 19:e0296387. [PMID: 38236816 PMCID: PMC10796019 DOI: 10.1371/journal.pone.0296387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Strong lines of evidence in the neuroscience literature indicate that (a) healthy sleep facilitates cognitive processing, and (b) sleep disruption is associated with cognitive dysfunction. Despite the fact that patients with pituitary disease often display both disrupted sleep and cognitive dysfunction, few previous studies investigate whether these clinical characteristics in these patients might be related. Hence, we explored whether sleep disruption in patients with pituitary disease mediates their cognitive dysfunction. We recruited 18 patients with non-functioning pituitary adenomas (NFPA) and 19 sociodemographically matched healthy controls. They completed the Global Sleep Assessment Questionnaire (thus providing self-report data regarding sleep disruption) and were administered the Brief Test of Adult Cognition by Telephone, which assesses cognitive functioning in the domains of processing speed, working memory, episodic memory, inhibition, and reasoning. We found no significant differences in cognition between patients and controls. Furthermore, spectra of sleep disturbance did not differ significantly between patients and controls. Our data suggest that NFPA patients' cognition and sleep quality is relatively intact, and that sleep disruption does not mediate cognitive dysfunction. Larger studies should characterize sleep and cognition in patients with NFPA (and other pituitary diseases) to confirm whether disruption of the former mediates impairment in the latter.
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Affiliation(s)
- Olivia de Villiers
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Claudia Elliot-Wilson
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Kevin G. F. Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Patrick L. Semple
- Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Thurandrie Naiker
- Department of Radiation Oncology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Michelle Henry
- Numeracy Centre, University of Cape Town, Cape Town, South Africa
| | - Ian L. Ross
- Division of Endocrinology, University of Cape Town, Cape Town, South Africa
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Cao C, Wen W, Chen A, Wang S, Xu G, Niu C, Song J. Neuropsychological Alterations of Prolactinomas' Cognitive Flexibility in Task Switching. Brain Sci 2023; 13:brainsci13010082. [PMID: 36672063 PMCID: PMC9856801 DOI: 10.3390/brainsci13010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
Prolactinomas have been reported to impair cognition in broad aspects. However, few studies investigated the influence of prolactinomas on cognitive flexibility never mentioning the underlying neural and electrophysiological mechanism. We recorded scalp electroencephalography (EEG) in a colour-shape switching task. Patients with prolactinomas showed longer reaction time in switch trials and larger switch costs relative to healthy controls (HCs). Compared to HCs who showed stronger frontal theta activity in switch trials, the generally weak frontal theta activity in patients implied that they could not afford the executive control to configure task sets. Meanwhile, machine-learning based classification revealed that patients manifested non-selective brain patterns in response to different task types (colour vs. shape task) and different task states (switch vs. repeat state), which collectively suggested the cognitive dysfunction in preparation for a changing environment. Compared to HCs who showed stronger frontoparietal synchronization in switch trials, this enhanced frontoparietal connectivity was disrupted among patients with severe prolactinomas. This finding implicated greater hyperprolactinemia was linked to a larger decrease in cognitive performance. Taken together, the present study highlighted frontal theta power, and frontoparietal connectivity at theta band as the electrophysiological markers of the impaired cognitive flexibility and task control in patients with prolactinomas.
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Affiliation(s)
- Chenglong Cao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
- Department of Cognitive Neuroscience, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430074, China
| | - Wen Wen
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Aobo Chen
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Shuochen Wang
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430074, China
| | - Guozheng Xu
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430074, China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
- Correspondence: (C.N.); (J.S.)
| | - Jian Song
- Department of Neurosurgery, The General Hospital of Chinese PLA Central Theater Command, Wuhan 430074, China
- Correspondence: (C.N.); (J.S.)
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Cao C, Song J, Lin P, Yan D, Yao S, Yue J, Liu B, Lu Y, Xu G. A Longitudinal, Prospective Study to Evaluate the Effects of Treatment on the Inhibitory Control Function After Transsphenoidal Surgery for Pituitary Adenomas. Clin EEG Neurosci 2021; 52:444-454. [PMID: 32412816 DOI: 10.1177/1550059420922744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Injured cognitive abilities have been reported in patients with pituitary adenoma. However, to date, few researchers have directly investigated the electrophysiological study of inhibitory control function of pituitary patients both pre- and postsurgery. Thus, this study aimed to identify the factors affecting the inhibitory control function of pituitary patients. METHODS Thirty presurgery pituitary patients were recruited and 26 patients of them completed the postsurgery follow-up. Thirty healthy people were recruited for control group. Visual Go/Nogo tasks were carried out by the patients and controls to assess the inhibitory control function before surgery and 6 months after the surgery, respectively. The function of inhibitory control was analyzed with the components of N2 and P3. RESULTS Across 3 groups, Nogo stimuli evoked larger frontal-central N2nogo and P3nogo than Go stimuli did. Furthermore, N2d of presurgery patients (-1.14 μV) and postsurgery patients(-0.61 μV) were significantly decreased compared with that of control group (-3.09 μV), F(2, 83) = 13.92, P < .01, whereas no difference was detected between pre- and postsurgery groups. There was no remarkable difference in the amplitude of P3d among the 3 groups, F(2, 83) = 0.19, P > .05. With regard to the amplitude of P3 for Go condition, The P3 amplitude of healthy group (4.38 μV) was larger than both pre- and postsurgery (1.00 μV and 3.01 μV). With regard to the amplitude of P3 for Nogo condition, The P3 amplitude of healthy group (5.25 μV) was larger than both pre- and postsurgery groups (2.35 μV and 4.18 μV). CONCLUSIONS These results indicated that presurgery patients showed the dysfunction of inhibition, due to the nerve tissue damage or brain structure alteration caused by the presurgery physical pressure from tumor and abnormal hormone levels. Postsurgery patients showed a tendency toward recovery, but there was no obvious improvement in the inhibitory control function after successful treatments.
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Affiliation(s)
- Chenglong Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, General Hospital of Central Theater of the Chinese People's Liberation Army, Wuhan, China
| | - Jian Song
- Department of Neurosurgery, General Hospital of Central Theater of the Chinese People's Liberation Army, Wuhan, China
| | - Pan Lin
- Department of Psychology, Hunan Normal University, Changsha, China
| | - Deqi Yan
- Department of Neurosurgery, The 990th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Zhumadian, China
| | - Shun Yao
- Department of Neurosurgery, General Hospital of Central Theater of the Chinese People's Liberation Army, Wuhan, China
| | - Jianren Yue
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Binbin Liu
- Wuhan University of Science and Technology, Wuhan, China
| | - Yuzhao Lu
- Wuhan University of Science and Technology, Wuhan, China
| | - Guozheng Xu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, General Hospital of Central Theater of the Chinese People's Liberation Army, Wuhan, China
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Slagboom TNA, Deijen JB, Van Bunderen CC, Knoop HA, Drent ML. Psychological well-being and illness perceptions in patients with hypopituitarism. Pituitary 2021; 24:542-554. [PMID: 33606176 PMCID: PMC8270855 DOI: 10.1007/s11102-021-01131-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary aim of the current study was to objectify a spectrum of persisting subjective psychological complaints in patients with hypopituitarism, at least six months after normalizing of the hormonal disturbances. Also, gender differences on these outcomes were investigated. The secondary aim was to identify illness perceptions and causal attributions within this patient group. METHODS A total of 42 adult participants (60% females) with treated hypopituitarism once filled out a number of psychological questionnaires. The Profile of Mood States (POMS) and the Hospital Anxiety and Depression Scale (HADS) assessed mood and the Symptom Checklist-90 (SCL-90) and the Work and Social Adjustment Scale (WSAS) assessed well-being. Illness perceptions were identified using the Illness Perceptions Questionnaire-Brief Dutch Language Version (IPQ-B DLV) and causal attributions by using the Causal Attribution List (CAL). Patient outcomes were compared to reference values of healthy norm groups. RESULTS Participants scored significantly worse on the POMS depression, anger, fatigue and tension subscales, the SCL-90 psychoneuroticism, depression, inadequacy of thinking and acting and sleeping problems subscales and all subscales of the WSAS when compared to reference data. Women also scored worse on depression (HADS) and somatic symptoms (SCL-90). Compared to other illnesses, patients with hypopituitarism have more negative and realistic illness perceptions on consequences, timeline, identity and emotions. Participants attributed their complaints more to physical causes than psychological causes. CONCLUSION Despite normalization of hormonal disturbances, patients with hypopituitarism in general can still experience problems during daily living, such as negative mood states and a decreased psychological well-being.
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Affiliation(s)
- Tessa N. A. Slagboom
- Section of Endocrinology, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jan Berend Deijen
- Section of Clinical Neuropsychology, Department of Clinical, Neuro- & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Van der Boechorstraat 7, 1081 BT Amsterdam, The Netherlands
- Hersencentrum Mental Health Institute Amsterdam, Amsterdam, The Netherlands
| | - Christa C. Van Bunderen
- Section of Endocrinology, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans A. Knoop
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Madeleine L. Drent
- Section of Endocrinology, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Section of Clinical Neuropsychology, Department of Clinical, Neuro- & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Van der Boechorstraat 7, 1081 BT Amsterdam, The Netherlands
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Slagboom TNA, Deijen JB, Van Bunderen CC, Knoop HA, Drent ML. Impaired neuropsychological functioning in patients with hypopituitarism. Endocrinol Diabetes Metab 2021; 4:e00165. [PMID: 33532607 PMCID: PMC7831215 DOI: 10.1002/edm2.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/13/2020] [Accepted: 06/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background Treatment of pituitary pathology mostly does not result in complete recovery of impairment in cognitive functioning. The primary aim of the current study was to assess cognitive impairment in patients with stable replacement therapy for hypopituitarism during the last 6 months prior to inclusion. It was expected that patients showed subjective and objective subnormal scores on neuropsychological functioning. Methods Forty-two patients (40% men, 49 ± 15 years) treated for hypopituitarism conducted a neuropsychological test battery, including the Cognitive Failures Questionnaire (CFQ), 15-Word test (15-WT), Cambridge Neuropsychological Test Automated Battery (CANTAB) Motor Screening Task (MOT), Spatial Working Memory (SWM) and Affective Go/No-go (AGN). Results were compared to reference values of healthy norm groups. Results Male and female participants scored significantly worse on the CFQ (P < .01, d = 0.91-4.09) and AGN mean correct latency (P < .01, d = 1.66 and 1.29, respectively). Female participants scored significantly worse on 15-WT direct recall (P = .01, d = 0.66), 15-WT delayed recall (P = .01, d = 0.79), SWM total errors (P = .05, d = 0.41), SWM strategy (P = .04, d = 0.43), AGN errors of commission (P = .02, d = 0.56) and omission (P = .04, d = 0.41). Conclusion This study shows that subjective cognitive functioning is worse in patients treated for hypopituitarism compared to reference data. Also, female participants treated for hypopituitarism score worse on objective aspects of memory and executive functioning compared to reference data. Besides worse focus attention, this objective cognitive impairment was not found in male participants. It is recommended to conduct additional research, which focuses on the design and evaluation of a cognitive remediation therapy, aimed at compensation of impairments in different aspects of memory and executive functioning.
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Affiliation(s)
- Tessa N. A. Slagboom
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Endocrinology, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Jan Berend Deijen
- Hersencentrum Mental Health InstituteAmsterdamThe Netherlands
- Section of Clinical NeuropsychologyDepartment of Clinical, Neuro‐ & Developmental PsychologyFaculty of Behavioral and Movement SciencesVrije UniversiteitAmsterdamThe Netherlands
| | - Christa C. Van Bunderen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Endocrinology, Amsterdam NeuroscienceAmsterdamThe Netherlands
| | - Hans A. Knoop
- Amsterdam UMC, University of Amsterdam, Department of Medical PsychologyAmsterdamThe Netherlands
| | - Madeleine L. Drent
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Endocrinology, Amsterdam NeuroscienceAmsterdamThe Netherlands
- Section of Clinical NeuropsychologyDepartment of Clinical, Neuro‐ & Developmental PsychologyFaculty of Behavioral and Movement SciencesVrije UniversiteitAmsterdamThe Netherlands
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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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Song J, Cao C, Wang Y, Yao S, Catalino MP, Yan D, Xu G, Ma L. Response Activation and Inhibition in Patients With Prolactinomas: An Electrophysiological Study. Front Hum Neurosci 2020; 14:170. [PMID: 32848659 PMCID: PMC7396600 DOI: 10.3389/fnhum.2020.00170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/20/2020] [Indexed: 11/25/2022] Open
Abstract
Impairment of executive function has been reported in patients with prolactinomas. However, few studies have investigated the electrophysiological mechanisms of response activation and response inhibition in these patients. In this study, we employ an event-related potentials (ERPs) technique to quantitatively assess response activation and inhibition before and after the surgical treatment of prolactinomas. A 64-electrode electroencephalogram (EEG) skullcap was used to record the brain activity in 20 pre-operative patients, 20 follow-up post-operative patients, and 20 healthy controls (HCs) while performing the visual Go/Nogo task. As expected, we identified P300 across all study populations that could reflect response activation and inhibition. Across the three groups, the Nogo stimuli evoked larger frontal-central P300 than the Go stimuli did. In contrast, the Go trials elicited larger parietal P300 than the Nogo trials did. The peak latency of P300 was significantly delayed in both the pre-operative and the post-operative groups compared to the HCs. The amplitude of P300 in both the Go and the Nogo conditions was significantly decreased in the pre-operative patients compared with that of the HCs. At 6 months post-operatively, the prolactinoma patients showed an increase in amplitude of P300 during both the Go and the Nogo tasks. These findings indicate that the prolactinoma patients suffer from deficits in response activation and inhibition, which could be improved by surgical treatment.
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Affiliation(s)
- Jian Song
- Department of Neurosurgery, The General Hospital of Chinese People's Liberation Army Central Theater Command, Wuhan, China
| | - Chenglong Cao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Wang
- Key Laboratory of Cognitive Science, College of Biomedical Engineering, South- Central University for Nationalities, Wuhan, China
| | - Shun Yao
- Center for Pituitary Tumor Surgery, Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael P Catalino
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, United States
| | - Deqi Yan
- Traditional Chinese Medicine College, Xinjiang Medical University, Urumqi, China
| | - Guozheng Xu
- Department of Neurosurgery, The General Hospital of Chinese People's Liberation Army Central Theater Command, Wuhan, China
| | - Lianting Ma
- Department of Neurosurgery, The General Hospital of Chinese People's Liberation Army Central Theater Command, Wuhan, China
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Piasecka M, Papakokkinou E, Valassi E, Santos A, Webb SM, de Vries F, Pereira AM, Ragnarsson O. Psychiatric and neurocognitive consequences of endogenous hypercortisolism. J Intern Med 2020; 288:168-182. [PMID: 32181937 DOI: 10.1111/joim.13056] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
Psychiatric and neurocognitive symptoms due to hypercortisolism were already described by Harvey Cushing in his original paper on patients with Cushing's syndrome (CS). Nowadays, it is well known that psychiatric and cognitive complaints are two of the most common, and most distressing, symptoms in patients with CS. Psychiatric symptoms are indeed a major clinical manifestation of CS. The most commonly observed psychiatric conditions are depression and anxiety, whilst mania and psychosis are less common. Several domains of cognitive function are impaired at diagnosis, including episodic and working memory, executive function and attention. Following treatment, one-fourth of the patients still experience depressed mood, and the cognitive impairments are only partially restored. Consequently, quality of life in patients with CS is severely and persistently affected. Neuroimaging studies have also illustrated the deleterious effects of hypercortisolism on the brain by demonstrating reduced grey matter volumes and cortical thickness, altered resting-state functional responses and during cognitive tasks, as well as widespread reduced white matter integrity, especially in structures important for cognitive function and emotional processing, both before and after successful abrogation of hypercortisolism. In this paper, we summarize the current knowledge on the psychiatric and neurocognitive consequences of hypercortisolism in patients with CS, both before, and after successful treatment. In addition, we review the structural and functional brain abnormalities associated with hypercortisolism and discuss the influence of these factors on quality of life.
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Affiliation(s)
- M Piasecka
- From the, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Papakokkinou
- From the, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Valassi
- IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, Univ Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain
| | - A Santos
- IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, Univ Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain
| | - S M Webb
- IIB-Sant Pau and Department of Endocrinology/Medicine, Hospital Sant Pau, Univ Autonoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, Barcelona, Spain
| | - F de Vries
- Department of Medicine, Division of Endocrinology, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Pereira
- Department of Medicine, Division of Endocrinology, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - O Ragnarsson
- From the, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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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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Tooze A, Sheehan JP. Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery. J Neurosurg 2019; 129:55-62. [PMID: 30544290 DOI: 10.3171/2018.7.gks181595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.METHODSThis was a retrospective, institutional review board-approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing's disease and those with nonfunctioning adenoma (NFA).RESULTSThe entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing's disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = -3.41, p = 0.003) and delayed memory (t = -3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.CONCLUSIONSOverall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.
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Affiliation(s)
- Alana Tooze
- 1Sussex Rehabilitation Centre, Princess Royal Hospital, Haywards Heath, Sussex, United Kingdom; and
| | - Jason P Sheehan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Jakobsson Ung E, Olofsson AC, Björkman I, Hallén T, Olsson DS, Ragnarsson O, Skoglund T, Jakobsson S, Johannsson G. The pre- and postoperative illness trajectory in patients with pituitary tumours. Endocr Connect 2019; 8:878-886. [PMID: 31176303 PMCID: PMC6599075 DOI: 10.1530/ec-19-0202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour. METHODS Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation. RESULTS Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present. CONCLUSIONS Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.
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Affiliation(s)
- Eva Jakobsson Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Ida Björkman
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Tobias Hallén
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Correspondence should be addressed to G Johannsson:
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Pertichetti M, Serioli S, Belotti F, Mattavelli D, Schreiber A, Cappelli C, Padovani A, Gasparotti R, Nicolai P, Fontanella MM, Doglietto F. Pituitary adenomas and neuropsychological status: a systematic literature review. Neurosurg Rev 2019; 43:1065-1078. [DOI: 10.1007/s10143-019-01134-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
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Castinetti F, Brue T, Ragnarsson O. Radiotherapy as a tool for the treatment of Cushing's disease. Eur J Endocrinol 2019; 180:D9-D18. [PMID: 30970325 DOI: 10.1530/eje-19-0092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/03/2019] [Indexed: 11/08/2022]
Abstract
Treatment of Cushing's disease (CD) is one of the most challenging tasks in endocrinology. The first-line treatment, transsphenoidal pituitary surgery, is associated with a high failure rate and a high prevalence of recurrence. Re-operation is associated with an even higher rate of a failure and recurrence. There are three main second-line treatments for CD - pituitary radiation therapy (RT), bilateral adrenalectomy and chronic cortisol-lowering medical treatment. All these treatments have their limitations. While bilateral adrenalectomy provides permanent cure of the hypercortisolism in all patients, the unavoidable chronic adrenal insufficiency and the risk of development of Nelson syndrome are of concern. Chronic cortisol-lowering medical treatment is not efficient in all patients and side effects are often a limiting factor. RT is efficient for approximately two-thirds of all patients with CD. However, the high prevalence of pituitary insufficiency is of concern as well as potential optic nerve damage, development of cerebrovascular disease and secondary brain tumours. Thus, when it comes to decide appropriate treatment for patients with CD, who have either failed to achieve remission with pituitary surgery, or patients with recurrence, the pros and cons of all second-line treatment options must be considered.
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Affiliation(s)
- Frederic Castinetti
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Marseille Medical Genetics, Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse, Marseille, France
| | - Thierry Brue
- Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale, Marseille Medical Genetics, Marseille, France
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'hypophyse, Marseille, France
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
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16
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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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Sanei Taheri M, Kimia F, Mehrnahad M, Saligheh Rad H, Haghighatkhah H, Moradi A, Kazerooni AF, Alviri M, Absalan A. Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency. Neuroradiol J 2018; 32:74-85. [PMID: 30501465 DOI: 10.1177/1971400918809825] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the accuracy of selected first or second-order histogram features in differentiation of functional types of pituitary macro-adenomas. MATERIALS AND METHODS Diffusion-weighted imaging magnetic resonance imaging was performed on 32 patients (age mean±standard deviation = 43.09 ± 11.02 years; min = 22 and max = 65 years) with pituitary macro-adenoma (10 with functional and 22 with non-functional tumors). Histograms of apparent diffusion coefficient were generated from regions of interest and selected first or second-order histogram features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and graded as containing <1%, 1-3%, and >3% of collagen. RESULTS Among selected first or second-order histogram features, uniformity ( p = 0.02), 75th percentile ( p = 0.03), and tumor smoothness ( p = 0.02) were significantly different between functional and non-functional tumors. Tumor smoothness > 5.7 × 10-9 (area under the curve = 0.75; 0.56-0.89) had 70% (95% confidence interval = 34.8-93.3%) sensitivity and 33.33% (95% confidence interval = 14.6-57.0%) specificity for diagnosis of functional tumors. Uniformity ≤179.271 had a sensitivity of 60% (95% confidence interval = 26.2-87.8%) and specificity of 90.48% (95% confidence interval = 69.6-98.8%) with area under the curve = 0.76; 0.57-0.89. The 75th percentile >0.7 had a sensitivity of 80% (95% confidence interval = 44.4-97.5%) and specificity of 66.67% (95% confidence interval = 43.0-85.4%) for categorizing tumors to functional and non-functional types (area under the curve = 0.74; 0.55-0.88). Using these cut-offs, smoothness and uniformity are suggested as negative predictive indices (non-functional tumors) whereas 75th percentile is more applicable for diagnosis of functional tumors. CONCLUSION First or second-order histogram features could be helpful in differentiating functional vs non-functional pituitary macro-adenoma tumors.
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Affiliation(s)
| | - Farnaz Kimia
- 1 Department of Radiology, Shahid Beheshti University of Medical Sciences, Iran
| | - Mersad Mehrnahad
- 1 Department of Radiology, Shahid Beheshti University of Medical Sciences, Iran
| | - Hamidreza Saligheh Rad
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | | | - Afshin Moradi
- 3 Department of Pathology, Shahid Beheshti University of Medical Sciences, Iran
| | - Anahita Fathi Kazerooni
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | - Mohammadreza Alviri
- 2 Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Iran
| | - Abdorrahim Absalan
- 4 Department of Medical Laboratory Sciences, Khomein University of Medical Sciences, Markazi Province, Iran
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Andela CD, Lobatto DJ, Pereira AM, van Furth WR, Biermasz NR. How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review. Pituitary 2018; 21:208-216. [PMID: 29302835 PMCID: PMC5849670 DOI: 10.1007/s11102-017-0860-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After treatment for a non-functioning pituitary adenoma (NFA) health-related quality of life (HR-QoL) improves considerably. However, the literature about the normalization of HR-QoL after treatment is inconclusive. Some researchers described a persistently decreased HR-QoL compared to reference data, while others did not. Considering this variety in observed HR-QoL outcomes, the aim of the present review was to provide a literature overview of health outcomes in patients with a NFA, using a conceptual HR-QoL model. A concrete conceptualization of the health outcomes of patients with a NFA can be helpful to understand the observed variety in HR-QoL outcomes and to improve clinical care and guidance of these patients. For this conceptualization, the Wilson and Cleary model was used. This model has a biopsychosocial character and has been validated in several patient populations. In the present review, health outcomes of patients with a NFA were described at each stage of the model e.g. biological and physiological variables, symptom status, functional status, general health perceptions and overall HR-QoL. The Wilson-Cleary model elucidates that elements at each stage of the model can contribute to the impairment in HR-QoL of patients with a NFA, which explains the reported variety in the literature. Furthermore, by applying the model, potential interventions targeting these elements can be identified. While optimal biomedical treatment has always been the focus, it is clearly not sufficient for good HR-QoL in patients with a NFA. Further improvement of HR-QoL should be supported by a pituitary specific care trajectory, including psychosocial care (e.g. self-management training), to beneficially affect characteristics of the patient and the (healthcare) environment, with the utmost goal to optimize HR-QoL in patients after treatment.
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Affiliation(s)
- Cornelie D Andela
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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19
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The dysfunction of processing task-irrelevant emotional faces in pituitary patients: an evidence from expression-related visual mismatch negativity. Neuroreport 2018; 29:328-333. [PMID: 29369901 DOI: 10.1097/wnr.0000000000000965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence showed impaired cognitive ability of patients with pituitary adenoma as an intracranial tumor. In the present study, we investigated the preattentive processing of emotional faces in pituitary adenoma patients by recording and analyzing the visual mismatch negativity elicited by deviant emotional faces. In the normal control group, deviant emotional faces elicited expression-related mismatch negativity (EMMN), with a more pronounced negative waveform for sad than happy face conditions. Compared with the normal group, EMMN related to sad faces was smaller in patients, whereas the EMMN related to happy faces remained the same. These data indicate the functional dysfunction of negative emotional processing at the preattentive stage of information processing in pituitary adenoma patients.
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20
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The dysfunction of inhibition control in pituitary patients: evidence from the Go/Nogo event-related potential study. Neuroreport 2018; 28:272-278. [PMID: 28225481 DOI: 10.1097/wnr.0000000000000757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pituitary tumor is an intracranial tumor; because of the development of neuroimaging technology in recent years, morbidity is likely to increase. Evidence showed impaired cognitive ability of patients with pituitary adenoma. There is evidence that neurobehavioral disorders are common in pituitary adenoma patients. This disorder is because of the cognitive and emotional function of the important functional areas of the brain oppressed and hormone imbalance. Individuals' mental activity is controlled by the brain and the abnormal mental activity is caused by both the structural abnormalities of the brain and neurochemical dysfunction. Event-related potentials have been used widely in the early assessment of cognitive functions associated with disease, taking advantage of the high temporal resolution, and then analyzing the characteristics of emotional competence from the perspective of cognitive processing. A visual Go/Nogo task was used. A larger Nogo-N2 and Nogo-P3 was found in the control group compared with the pituitary group. This reflects the nonphysiological process of conflict monitoring and inhibitory control in pituitary patients. The results also showed that the difference waves between Go and Nogo conditions (N2d and P3d) over the frontal electrode sites were more robust and earlier in the control group compared with the pituitary group, which reflects frontal dysfunction in the pituitary group. These data suggest reduced earlier and later stages of inhibitory processes in pituitary individuals, implicating the dysfunction of conflict detection and inhibitory control.
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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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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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Wouters HJCM, van Loon HCM, van der Klauw MM, Elderson MF, Slagter SN, Kobold AM, Kema IP, Links TP, van Vliet-Ostaptchouk JV, Wolffenbuttel BHR. No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters, Health-Related Quality of Life, and Cognitive Functioning in a Large Population-Based Cohort Study. Thyroid 2017; 27:147-155. [PMID: 27786042 DOI: 10.1089/thy.2016.0199] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The presence of the Thr92Ala polymorphism of deiodinase-2 (D2) has been thought to have several effects. It may influence its enzymatic function, is associated with increased expression of genes involved in oxidative stress in brain tissue, and may predict favorable response to combination levothyroxine (LT4) plus triiodothyronine (T3) therapy. It was hypothesized that homozygous carriers of the D2-92Ala allele have different thyroid hormone parameters, and reduced health-related quality of life (HRQoL) and cognitive functioning. METHODS In 12,625 participants from the LifeLines cohort study with genome-wide genetic data available, the effects of the Thr92Ala polymorphism (rs225014) were evaluated in the general population and in 364 people treated with thyroid hormone replacement therapy, the latter mainly because of primary hypothyroidism. In addition to evaluating anthropometric data, medication use, and existence of metabolic syndrome, HRQoL was assessed with the RAND 36-Item Health Survey, and the Ruff Figural Fluency Test was used as a sensitive test for executive functioning. Data on thyrotropin, free thyroxine (fT4), and free T3 (fT3) levels were available in a subset of 4479 participants. RESULTS The mean age (±standard deviation) was 53 ± 12 years and the body mass index was 27.0 ± 4.5 kg/m2 in the LT4 users compared with 48 ± 11 years and 26.2 ± 4.1 kg/m2 in participants from the general population. The Ala/Ala genotype of the D2-Thr92Ala polymorphism was present in 11.3% of LT4 users and in 10.7% of the general population. In total, 3742/4479 subjects with thyroid hormone data available had normal TSH (0.4-4.0 mIU/L), and 88% of LT4 users were females. LT4 users had higher fT4, lower fT3, and a lower fT3/fT4 ratio, and female patients had lower scores on the HRQoL domains of physical functioning, vitality, mental health, social functioning, bodily pain, and general health compared with those not using LT4 (p < 0.005). Executive functioning scores, as part of cognitive functioning, were comparable between female LT4 users and the general population. In both groups, the D2-Thr92Ala polymorphism was not associated with differences in TSH, fT4, fT3, the fT3/fT4 ratio, presence of metabolic syndrome or other comorbidities, use of medication, HRQoL, and cognitive functioning. CONCLUSION The Thr92Ala polymorphism of D2 was not associated with thyroid parameters, HRQoL, and cognitive functioning in the general population and in participants on thyroid hormone replacement therapy.
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Affiliation(s)
- Hanneke J C M Wouters
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Hannah C M van Loon
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Melanie M van der Klauw
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Martin F Elderson
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Sandra N Slagter
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Anneke Muller Kobold
- 2 Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Ido P Kema
- 2 Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Thera P Links
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Jana V van Vliet-Ostaptchouk
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Bruce H R Wolffenbuttel
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
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Pereira AM. Long-term effects of treatment of pituitary adenomas. HANDBOOK OF CLINICAL NEUROLOGY 2016; 124:361-71. [PMID: 25248599 DOI: 10.1016/b978-0-444-59602-4.00024-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pituitary adenomas can be treated effectively in the vast majority of cases. After successful treatment for pituitary disease, many patients still report reduced quality of life in the presence of persistent morbidity and (slightly) increased mortality. At present, there is an increasing awareness that in many cases long-term remission of functioning or nonfunctioning adenomas does not equal cure. The causes are most probably multifactorial. Hypopituitarism, intrinsic imperfections of surgical or endocrine replacement therapy, but also persistent effects of treatment and of previous hormone excess on the central nervous system all affect long-term morbidity, general well-being, and mortality. This implies that treatment goals for patients with pituitary adenomas will shift from long-term cure to long-term care. Further research is therefore needed to get more insight into each of these factors of influence, such as the extent of reversibility of hormone excess syndromes on cardiovascular risk and behavior. The fact that coping strategies, despite long-term remission, are altered and illness perceptions are affected strongly suggests that long-term care should incorporate self-management interventions that might help to improve quality of life for patients.
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Affiliation(s)
- Alberto M Pereira
- Department of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
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Lee MH, Lee JH, Seol HJ, Lee JI, Kim JH, Kong DS, Nam DH. Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma. Brain Tumor Res Treat 2016; 4:1-7. [PMID: 27195254 PMCID: PMC4868810 DOI: 10.14791/btrt.2016.4.1.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/05/2016] [Accepted: 04/06/2016] [Indexed: 12/19/2022] Open
Abstract
Background Non-functioning pituitary adenomas (NFPA) are clinically challenging because they present at a late stage with local mass effects or hypopituitarism. Surgery for non-functioning pituitary adenoma requires a special strategic approach for both minimal morbidity and radical resection. However, the clinical predictive factors associated with recurrence are limited. Here, we investigated optimal treatment of non-functioning pituitary adenoma. Methods We enrolled 289 patients who presented with non-functioning pituitary adenoma between January 2000 and January 2012 and who had received follow-up for at least one year for this retrospective study. Of these patients, 152 were male and 137 were female, with a median age of 51 years (range 15.79 years) and a median follow-up of four years (range 1.12.6 years). Characteristics of patients and tumors were reviewed with electronic medical records and radiologic images, retrospectively. Results Of the tumors, 193 were gross-totally resected, 53 were near-totally resected, and 43 were sub-totally resected. The extent of resection and adjuvant radiotherapy were both statistically significant prognostic factors of recurrence. Immunohistochemistry of tumor specimens did not yield consistent results. Conclusion With a high rate of recurrence, NFPA should be closely followed-up over a long-term period. Improvement of surgical techniques with advanced surgical equipment and adjuvant radiosurgery would lead to reduce the recurrence rate and improve patients' outcome.
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Affiliation(s)
- Min Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Konyang University Hospital, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Karppinen A, Ritvonen E, Roine R, Sintonen H, Vehkavaara S, Kivipelto L, Grossman AB, Niemelä M, Schalin-Jäntti C. Health-related quality of life in patients treated for nonfunctioning pituitary adenomas during the years 2000-2010. Clin Endocrinol (Oxf) 2016; 84:532-9. [PMID: 26493182 DOI: 10.1111/cen.12967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/23/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The published data on health-related quality of life (HRQoL) after treatment of nonfunctioning pituitary adenomas (NFPAs) are conflicting. We evaluated HRQoL in a recent series of patients who had surgery for an NFPA. DESIGN Cross-sectional study including a large control population. PATIENTS AND MEASUREMENTS A HRQoL questionnaire (15D) was sent to all patients (n = 161) having undergone transsphenoidal surgery for NFPA in the years 2000-2010 at the Helsinki University Hospital. The 15D score and dimension scores of the study population (n = 137) were compared with those of a large (n = 4967) gender- and age-standardized control population. Possible independent predictors of HRQoL in the patients were estimated with multivariate regression analysis. RESULTS Postoperatively, 57% of the patients had normal visual function. After a mean follow-up of 7·4 ± 3·2 years (mean ± SD), 62% suffered from hypopituitarism. Overall, HRQoL was near-normal in patients compared to controls (15D scores 0·885 ± 0·114 vs 0·903 ± 0·093, respectively, P = 0·07). On single dimensions, patients had impaired vision and sexual activity (both P < 0·0005), more depression and distress (both P < 0·005) and less discomfort and symptoms (P < 0·05). Age, body mass index, diabetes, depression and reoperation were independent predictors of impaired HRQoL (all P < 0·05). Thyroxine substitution was associated with impaired and hydrocortisone and testosterone substitution (males only) with better HRQoL (all P < 0·05). CONCLUSIONS This recent series of NFPA patients demonstrates that overall HRQoL is near-normal after medium term follow-up; the most impaired dimensions were in vision and sexual activity. Comorbidities are strong predictors of impaired HRQoL.
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Affiliation(s)
- Atte Karppinen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elina Ritvonen
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Satu Vehkavaara
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Kivipelto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashley B Grossman
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology & Metabolism, Churchill Hospital, University of Oxford, UK
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Hannon MJ, Barkan AL, Drake WM. The Role of Radiotherapy in Acromegaly. Neuroendocrinology 2016; 103:42-9. [PMID: 26088716 DOI: 10.1159/000435776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022]
Abstract
Radiotherapy has, historically, played a central role in the management of acromegaly, and the last 30 years have seen substantial improvements in the technology used in the delivery of radiation therapy. More recently, the introduction of highly targeted radiotherapy, or 'radiosurgery', has further increased the therapeutic options available in the management of secretory pituitary tumors. Despite these developments, improvements in primary surgical outcomes, an increase in the range and effectiveness of medical therapy options, and long-term safety concerns have combined to dictate that, although still deployed in selected cases, the use of radiotherapy in the management of acromegaly has declined steadily over the past 2 decades. In this article, we review some of the main studies that have documented the efficacy of pituitary radiotherapy on growth hormone hypersecretion and summarize the data around its potential deleterious effects, including hypopituitarism, cranial nerve damage, and the development of radiation-related intracerebral tumors. We also give practical recommendations to guide its future use in patients with acromegaly, generally, as a third-line intervention after neurosurgical intervention in combination with various medical therapy options.
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Affiliation(s)
- Mark J Hannon
- Department of Endocrinology, St. Bartholomew's Hospital, London, UK
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Qiao N, Zhang Y, Ye Z, Shen M, Shou X, Wang Y, Li S, Wang M, Zhao Y. Comparison of multifocal visual evoked potential, static automated perimetry, and optical coherence tomography findings for assessing visual pathways in patients with pituitary adenomas. Pituitary 2015; 18:598-603. [PMID: 25349031 DOI: 10.1007/s11102-014-0613-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND There have been no studies investigating the correlation between structural [thickness of the retinal nerve fiber layer (RNFL) as determined by optical coherence tomography (OCT)] and functional [Humphrey visual field (HVF) or visual evoked potential (VEP) amplitude] measures of optic nerve integrity in patients with pituitary adenomas (PA). METHODS Patients with PAs were recruited between September 2010 and September 2013. OCT, standard automated perimetry (SAP), and multifical VEP (mfVEP) were performed. Agreement between OCT, SAP, and mfVEP values in classifying eyes/quadrants was determined using AC1 statistics. Pearson's correlation was used to examine relationships between structural and functional data. RESULTS In total, 88.7% of the eyes tested showed abnormal SAP findings and 93.7% showed abnormal mfVEP findings. Only 14.8% of the eyes showed abnormal OCT findings. The agreement between SAP and mfVEP findings was 88.9% (AC1 = 0.87). The agreement between OCT and mfVEP findings was 24.2% (AC1 = -0.52), and that between OCT and SAP findings was 21.5% (AC1 = -0.56). The correlation values between RNFL thickness and the functional measurements were -0.601 for the mfVEP score (P = 0.000) and -0.441 for the SAP score (P = 0.000). The correlation between the mfVEP and SAP scores was -0.617 (P = 0.000). CONCLUSIONS mfVEP, SAP, and OCT provided complementary information for detecting visual pathway abnormalities in patients with PAs. Good agreement was demonstrated between SAP and mfVEP and quantitative analysis of structure-function measurements revealed a moderate correlation.
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Affiliation(s)
- Nidan Qiao
- Shanghai Pituitary Tumor Center, Department of Neurosurgery, HuaShan Hospital, Shanghai Medical College, Fudan University, 12# Middle Wulumuqi Road, Shanghai, 200040, China
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Werumeus Buning J, Brummelman P, Koerts J, Dullaart RPF, van den Berg G, van der Klauw MM, Tucha O, Wolffenbuttel BHR, van Beek AP. The effects of two different doses of hydrocortisone on cognition in patients with secondary adrenal insufficiency--results from a randomized controlled trial. Psychoneuroendocrinology 2015; 55:36-47. [PMID: 25705800 DOI: 10.1016/j.psyneuen.2015.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 12/22/2022]
Abstract
CONTEXT A wide variety in hydrocortisone (HC) substitution dose-regimens are considered physiological for patients with secondary adrenal insufficiency (SAI). However, it is likely that cognition is negatively influenced by higher cortisol exposure to the brain. OBJECTIVE To examine the effects of a high physiological HC dose in comparison to a low physiological HC dose on cognition. DESIGN AND SETTING This study was a randomized double blind cross-over study at the University Medical Center Groningen. This study is registered with ClinicalTrials.gov, number NCT01546922. PATIENTS Forty-seven patients (29 males, 18 females; mean [SD] age, 51 [14] years, range 19-73) with SAI participated. INTERVENTION(S) Patients randomly received first a low dose of HC (0.2-0.3 mg/kg body weight/day) during 10 weeks followed by a high dose (0.4-0.6 mg/kg body weight/day) for another 10 weeks, or vice versa. HC substitution was given in three divided doses with the highest dose in the morning. MAIN OUTCOME MEASURE(S) Cognitive performance (memory, attention, executive functioning and social cognition) of patients was measured at baseline and after each treatment period using a battery of 12 standardized cognitive tests. RESULTS The higher dose of HC resulted in significantly higher systemic cortisol exposure for example measured at 1h after first dose ingestion (mean [SD], low dose: 653 [281] nmol/L; high dose: 930 [148] nmol/L; P<0.001). No differences in cognitive performance were found between the two dose regimens. CONCLUSIONS No negative influence on memory, attention, executive functioning and social cognition was observed after 10 weeks of treatment with a higher physiological dose of HC in patients with SAI when compared to a lower dose.
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Affiliation(s)
- Jorien Werumeus Buning
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - Pauline Brummelman
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Melanie M van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, De Brug, AA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Brummelman P, Sattler MG, Meiners LC, van den Berg G, van der Klauw MM, Elderson MF, Dullaart RP, Koerts J, Werumeus Buning J, Tucha O, Wolffenbuttel BH, van den Bergh AC, van Beek AP. Cognition and brain abnormalities on MRI in pituitary patients. Eur J Radiol 2015; 84:295-300. [DOI: 10.1016/j.ejrad.2014.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Sattler MGA, Meiners LC, Sluiter WJ, van den Berg G, Langendijk JA, Wolffenbuttel BHR, van den Bergh ACM, van Beek AP. Brain abnormalities on MRI in non-functioning pituitary adenoma patients treated with or without postoperative radiotherapy. Radiother Oncol 2015; 114:239-44. [PMID: 25596913 DOI: 10.1016/j.radonc.2015.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/27/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE To assess and compare brain abnormalities on Magnetic Resonance Imaging (MRI) in non-functioning pituitary macro-adenoma (NFA) patients treated with or without postoperative radiotherapy (RT). MATERIAL AND METHODS In 86 NFA patients, treated between 1987 and 2008 at the University Medical Center Groningen, white-matter lesions (WMLs), cerebral atrophy, brain infarctions and abnormalities of the temporal lobes and hippocampi were assessed on pre- and post-treatment MRI scans in patients treated with (n=47) or without RT. RESULTS The median MRI follow-up time for RT patients was 10 (range 1-22) years and 5 (range 1-21) years in patients treated without RT. In RT patients the cumulative incidence of WMLs was significantly lower compared to patients treated without RT (log-rank test RR 0.49, 95% CI 0.25-0.97, p=.042). The cumulative incidences of cerebral atrophy, brain infarctions, abnormalities of the temporal lobes and hippocampi, and the severity of WMLs and cerebral atrophy ratings were not significantly different between the two treatment groups. CONCLUSIONS Brain abnormalities on MRI are not observed more frequently in NFA patients treated with RT compared to patients treated with surgery-alone. Furthermore, RT was not associated with an increased severity of WMLs and cerebral atrophy ratings in this cohort of NFA patients.
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Affiliation(s)
- Margriet G A Sattler
- Departments of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Linda C Meiners
- Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gerrit van den Berg
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Departments of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alphons C M van den Bergh
- Departments of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, The Netherlands
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Nelson’s syndrome: Single centre experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy. J Clin Neurosci 2014; 21:1520-4. [DOI: 10.1016/j.jocn.2013.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/30/2013] [Indexed: 11/20/2022]
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Freeman JL, Weber GJ, Peterson SM, Nie LH. Embryonic ionizing radiation exposure results in expression alterations of genes associated with cardiovascular and neurological development, function, and disease and modified cardiovascular function in zebrafish. Front Genet 2014; 5:268. [PMID: 25147559 PMCID: PMC4124797 DOI: 10.3389/fgene.2014.00268] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/21/2014] [Indexed: 01/16/2023] Open
Abstract
The relationship between ionizing radiation (IR) and carcinogenesis is long established, but recently the association between IR and other diseases is starting to be recognized. Currently, there is limited information on the genetic mechanisms governing the role of IR in non-cancer related adverse health effects and in regards to an early developmental exposure. In this study, zebrafish embryos were exposed to a range of IR doses (0, 1, 2, 5, 10 Gy) at 26 h post fertilization (hpf). No significant increase in mortality or hatching rate was observed, but a significant decrease in total larval length, head length, and eye diameter was observed in the 10 Gy dose. Transcriptomic analysis was conducted at 120 hpf to compare gene expression profiles between the control and highest IR dose at which no significant differences were observed in morphological measurements (5 Gy). 253 genes with well-established function or orthology to human genes were significantly altered. Gene ontology and molecular network analysis revealed enrichment of genes associated with cardiovascular and neurological development, function, and disease. Expression of a subset of genetic targets with an emphasis on those associated with the cardiovascular system was assessed using Quantitative PCR (qPCR) to confirm altered expression at 5 Gy and then to investigate alterations at lower doses (1 and 2 Gy). Strong correlation between microarray and qPCR expression values was observed, but zebrafish exposed to 1 or 2 Gy resulted in a significant expression alteration in only one of these genes (LIN7B). Moreover, heart rate was analyzed through 120 hpf following IR dosing at 26 hpf. A significant decrease in heart rate was observed at 10 Gy, while a significant increase in heart rate was observed at 1, 2, and 5 Gy. Overall these findings indicate IR exposure at doses below those that induce gross morphological changes alters heart rate and expression of genes associated with cardiovascular and neurological functions.
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Affiliation(s)
| | - Gregory J Weber
- School of Health Sciences, Purdue University West Lafayette, IN, USA
| | - Samuel M Peterson
- School of Health Sciences, Purdue University West Lafayette, IN, USA
| | - Linda H Nie
- School of Health Sciences, Purdue University West Lafayette, IN, USA
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Cámara Gómez R. Tumores hipofisarios no funcionantes: actualización 2012. ACTA ACUST UNITED AC 2014; 61:160-70. [DOI: 10.1016/j.endonu.2013.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 01/10/2023]
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Abstract
During the last 20 years a tremendous improvement in the care of patients with pituitary tumors and of hypopituitarism has been achieved. If we resolve most of the possible causes of the increased cardiovascular disease and stroke mortality a normal survival is expected in these patients. Recently, a large population based study showed a decline in the risk of non-fatal stroke and of non-fatal cardiac events in GH deficient patients. This improvement was achieved by complete hormone replacement, including long term GH replacement, together with prescription of cardio protective drugs. If we follow the latest achievements in pituitary imaging, surgery techniques, hormone substitutions, cardio protective medications, we would expect a normal longevity in these patients. This review will focus on; (1) pituitary insufficiencies and hormone substitutions, (2) modes of cranial radiotherapy, and (3) new techniques in the surgery of a pituitary adenoma.
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Affiliation(s)
- Eva Marie Erfurth
- Department of Endocrinology, Skånes University Hospital, 221 85, Lund, Sweden.
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Capatina C, Christodoulides C, Fernandez A, Cudlip S, Grossman AB, Wass JAH, Karavitaki N. Current treatment protocols can offer a normal or near-normal quality of life in the majority of patients with non-functioning pituitary adenomas. Clin Endocrinol (Oxf) 2013; 78:86-93. [PMID: 22640418 DOI: 10.1111/j.1365-2265.2012.04449.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/02/2012] [Accepted: 05/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Non-functioning pituitary adenomas (NFA) may be associated with significant morbidity. Published data on the quality of life (QoL) of patients with NFA are scarce and conflicting. In view of the discordant findings and the advances in the management of these subjects, we aimed to evaluate the QoL in patients with NFA followed up in a tertiary endocrine UK referral centre. SUBJECTS AND METHODS All consecutive patients with NFA attending the outpatient clinic in the Department of Endocrinology in Oxford over a 6-month period (n = 193) were offered 3 health-related QoL questionnaires [Short Form 36 (SF36), Nottingham Health Profile (NHP), European Quality of Life Scale (EuroQoL)] to complete. Patient outcomes (response rate 93.3%) were compared with age-related UK reference values. RESULTS None of the QoL scores in the SF-36 or the 5 dimensions of health in the EuroQoL was different from the reference values. The visual analogue scale (VAS) score (EuroQoL) was slightly compromised (P = 0.041). In the NHP questionnaire, males had no parameter significantly affected, whereas females performed worse in 1/6 areas (energy levels). Tumour recurrence was an independent predictor for compromised VAS score and for anxiety/depression (EuroQoL), and visual field defects for more frequent problems with interests/hobbies (NHP). CONCLUSIONS Overall, the health-related QoL and perception of subjective health in patients with NFA was not compromised to any major extent suggesting that we can now offer the prospect of treatment and replacement, which will provide a normal or near-normal QoL. Specific groups are affected in various dimensions, necessitating measures to compensate for predisposing factors.
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Affiliation(s)
- Cristina Capatina
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
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Brummelman P, Koerts J, Dullaart RPF, van den Berg G, Tucha O, Wolffenbuttel BHR, van Beek AP. Effects of previous growth hormone excess and current medical treatment for acromegaly on cognition. Eur J Clin Invest 2012; 42:1317-24. [PMID: 23083406 DOI: 10.1111/j.1365-2362.2012.02721.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this study was to compare cognitive functioning of patients who are treated for acromegaly with patients with non-functioning pituitary adenomas (NFA). In addition, we assessed the influence of prolonged medical treatment after initial transsphenoidal surgery on cognition. DESIGN In this cross-sectional study, 74 patients participated, who were treated for acromegaly (n = 50; median [interquartile range] age: 53 [45-65] years) or NFA (n = 24; age: 63 [59-70] years). The NFA patients were selected for a high likelihood of normal GH secretion based on an IGF-1 z-score within the normal range (> -2) and zero or one axis substituted. Of the acromegaly patients, 28 had achieved remission, while 22 were biochemically controlled with long-acting somatostatin analogues and/or pegvisomant. Memory and executive functioning were assessed by the 15 Words Test and the Ruff Figural Fluency Test, and reported as z-scores. RESULTS The total patient group scored significantly poorer than the reference population on memory and executive functioning (P < 0·001). However, cognitive test performance was not significantly different between acromegaly patients with a persistent disease, acromegaly patients in remission and NFA patients. CONCLUSION The total patient group scored worse compared with reference populations. We found no association between previous GH excess and cognition. In addition, current medical treatment for GH excess in acromegaly was not related to memory and executive functioning.
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Affiliation(s)
- Pauline Brummelman
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Tucha L, Aschenbrenner S, Koerts J, Lange KW. The five-point test: reliability, validity and normative data for children and adults. PLoS One 2012; 7:e46080. [PMID: 23029395 PMCID: PMC3454354 DOI: 10.1371/journal.pone.0046080] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 08/28/2012] [Indexed: 11/20/2022] Open
Abstract
The present study provides normative data from a sample of 257 healthy children and 608 adults on a modified version of the Five-Point Test (5PT). The 5PT is a structured and standardized test measuring figural fluency functions. Interrater reliability, test-retest-reliability and construct validity of this measure were analyzed. The sensitivity of the task for cognitive disturbances of patients with neurological diseases was proven by analyzing the test performance in the 5PT of patients with Parkinson's disease. Finally, normative data stratified by age and corrected for education level is provided. The results of the present study confirm the value of the 5PT in the measurement of figural fluency functions in clinical examination and neuropsychological research.
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Affiliation(s)
- Lara Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, The Netherlands.
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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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Postma MR, Netea-Maier RT, van den Berg G, Homan J, Sluiter WJ, Wagenmakers MA, van den Bergh ACM, Wolffenbuttel BHR, Hermus ARMM, van Beek AP. Quality of life is impaired in association with the need for prolonged postoperative therapy by somatostatin analogs in patients with acromegaly. Eur J Endocrinol 2012; 166:585-92. [PMID: 22250074 DOI: 10.1530/eje-11-0853] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the influence of long-acting somatostatin analogs (SSTA) after initial pituitary surgery on long-term health-related quality of life (HR-QoL) in relation to disease control in patients with acromegaly. DESIGN This is a cross-sectional study in two tertiary referral centers in The Netherlands. PATIENTS AND METHODS One hundred and eight patients with acromegaly, in whom transsphenoidal (n=101, 94%) or transcranial (n=7, 6%) surgery was performed. Subsequently, 46 (43%) received additional radiotherapy and 41 (38%) were on postoperative treatment with SSTA because of persistent or recurrent disease at the time of study. All subjects filled in standardized questionnaires measuring HR-QoL. Disease control at the time of study was assessed by local IGF1 SDS. RESULTS IGF1 SDS were slightly higher in patients treated with SSTA in comparison with patients without use of SSTA (0.85±1.52 vs 0.25±1.21, P=0.026), but the percentage of patients with insufficient control (IGF1 SDS >2) was not different (17 vs 9%, P=0.208). Patients using SSTA reported poorer scores on most subscales of the RAND-36 and the acromegaly QoL and on all subscales of the multidimensional fatigue inventory-20. A subgroup analysis in patients with similar IGF1 levels (SSTA+, n=26, IGF1 SDS 0.44±0.72 vs SSTA-, n=44, IGF1 SDS 0.41±0.65) revealed worse scores on physical functioning, physical fatigue, reduced activity, vitality, and general health perception across all HR-QoL questionnaires in patients treated with SSTA. CONCLUSION QoL is impaired in association with the need for prolonged postoperative therapy by SSTA in patients with acromegaly despite similar IGF1 levels.
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Affiliation(s)
- Mark R Postma
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Wilson P, De-loyde K, Williams J, Smee R. A single centre’s experience of stereotactic radiosurgery and radiotherapy for non-functioning pituitary adenomas with the Linear Accelerator (Linac). J Clin Neurosci 2012; 19:370-4. [DOI: 10.1016/j.jocn.2011.07.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 07/11/2011] [Indexed: 11/28/2022]
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Brummelman P, Sattler MGA, Meiners LC, Elderson MF, Dullaart RPF, van den Berg G, Koerts J, Tucha O, Wolffenbuttel BHR, van den Bergh ACM, van Beek AP. Cognitive performance after postoperative pituitary radiotherapy: a dosimetric study of the hippocampus and the prefrontal cortex. Eur J Endocrinol 2012; 166:171-9. [PMID: 22071311 DOI: 10.1530/eje-11-0749] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The hippocampus and prefrontal cortex (PFC) are important for memory and executive functioning and are known to be sensitive to radiotherapy (RT). Radiation dosimetry relates radiation exposure to specific brain areas. The effects of various pituitary RT techniques were studied by relating detailed dosimetry of the hippocampus and PFC to cognitive performance. METHODS In this cross-sectional design, 75 non-functioning pituitary macroadenoma (NFA) patients (61±10 years) participated and were divided into irradiated (RT+, n=30) and non-irradiated (RT-, n=45) groups. The RT+ group (who all received 25 fractions of 1.8 Gy; total dose: 45 Gy) consisted of three RT technique groups: three-field technique, n=10; four-field technique, n=15; and five-field technique, n=5. Memory and executive functioning were assessed by standardized neuropsychological tests. A reconstruction of the dose distributions for the three RT techniques was made. The RT doses on 30, 50, and 70% of the volume of the left and right hippocampus and PFC were calculated. RESULTS Cognitive test performance was not different between the four groups, despite differences in radiation doses applied to the hippocampi and PFC. Age at RT, time since RT, and the use of thyroid hormone varied significantly between the groups; however, they were not related to cognitive performance. CONCLUSION This study showed that there were no significant differences on cognitive performance between the three-, four-, and five-field RT groups and the non-irradiated patient group. A dose-response relationship could not be established, even with a radiation dose that was higher on most of the volume of the hippocampus and PFC in case of a four-field RT technique compared with the three- and five-field RT techniques.
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Affiliation(s)
- Pauline Brummelman
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, De Brug 4.065, AA31, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Weber DC, Momjian S, Pralong FP, Meyer P, Villemure JG, Pica A. Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma. Radiat Oncol 2011; 6:169. [PMID: 22152397 PMCID: PMC3248375 DOI: 10.1186/1748-717x-6-169] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/08/2011] [Indexed: 11/10/2022] Open
Abstract
Purpose To evaluate the efficacy and toxicity of stereotactic fractionated radiotherapy (SFRT) for patients with pituitary macroadenoma (PMA). Methods and Materials Between March 2000 and March 2009, 27 patients (male to female ratio, 1.25) with PMA underwent SFRT (median dose, 50.4 Gy). Mean age of the patients was 56.5 years (range, 20.3 - 77.4). In all but one patient, SFRT was administered for salvage treatment after surgical resection (transphenoidal resection in 23, transphenoidal resection followed by craniotomy in 2 and multiple transphenoidal resections in another patient). In 10 (37%) patients, the PMAs were functional (3 ACTH-secreting, 3 prolactinomas, 2 growth hormone-secreting and 2 multiple hormone-secretion). Three (11.1%) and 9 (33.3%) patients had PMA abutting and compressing the optic chiasm, respectively. Mean tumor volume was 2.9 ± 4.6 cm3. Eighteen (66.7%) patients had hypopituitarism prior to SFRT. The mean follow-up period after SFRT was 72.4 ± 37.2 months. Results Tumor size decreased for 6 (22.2%) patients and remained unchanged for 19 (70.4%) other patients. Two (7.4%) patients had tumor growth inside the prescribed treatment volume. The estimated 5-year tumor growth control was 95.5% after SFRT. Biochemical remission occurred in 3 (30%) patients with functional PMA. Two patients with normal anterior pituitary function before SFRT developed new deficits 25 and 65 months after treatment. The 5-year survival without new anterior pituitary deficit was thus 95.8%. Five patients with visual field defect had improved visual function and 1 patient with no visual defect prior to SFRT, but an optic chiasm abutting tumor, had a decline in visual function. The estimated 5-year vision and pituitary function preservation rates were 93.2% and 95.8%, respectively. Conclusions SFRT is a safe and effective treatment for patients with PMA, although longer follow-up is needed to evaluate long-term outcomes. In this study, approximately 1 patient with visual field defect out of two had an improved visual function.
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Affiliation(s)
- Damien C Weber
- Department of Radiation Oncology, Geneva University Hospital, 1211 Geneva, Switzerland.
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