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Störmann S, Cuny T. The socioeconomic burden of acromegaly. Eur J Endocrinol 2023; 189:R1-R10. [PMID: 37536267 DOI: 10.1093/ejendo/lvad097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
Acromegaly is a rare and insidious disease characterized by chronic excess growth hormone, leading to various morphological changes and systemic complications. Despite its low prevalence, acromegaly poses a significant socioeconomic burden on patients and healthcare systems. This review synthesizes the current state of knowledge on the psychosocial burden, disability, impact on daily life, and cost of acromegaly disease, focusing on the quality of life, partnership, medical care and treatment afflictions, participation in daily activities, professional and leisure impairment, and cost of treatment for acromegaly and its comorbidities. It also examines management strategies, coping mechanisms, and interventions aimed at alleviating this burden. A comprehensive understanding of the extent of the socioeconomic burden in acromegaly is crucial to develop effective strategies to improve treatment and care. Further research is warranted to explore the myriad factors contributing to this burden, as well as the efficacy of interventions to alleviate it, ultimately enhancing the quality of life for patients with acromegaly.
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Affiliation(s)
- Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Thomas Cuny
- Department of Endocrinology, Aix Marseille University, MMG, INSERM U1251, MarMaRa Institute, CRMR HYPO, Marseille 13385, France
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2
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Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly. J Clin Med 2023; 12:jcm12062283. [PMID: 36983284 PMCID: PMC10058029 DOI: 10.3390/jcm12062283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Acromegaly is a chronic disease caused by the overproduction of growth hormone (GH) and accompanying insulin-like growth factor-1 (IGF-1), which is often caused by GH-secreting pituitary adenomas. In addition to its somatic burden, a growing number of studies have found that patients suffering from acromegaly exhibit psychosocial and personality changes. Over the past 70 years, there has been increasing interest in the cognitive impairment and neuropsychological issues of patients with acromegaly, and a variety of neuropsychological and neurophysiological tests have been used to measure cognitive changes in patients. The impact of disease progression status, treatment modalities, and various comorbidities on cognitive function and the mechanisms of cognitive impairment in patients with acromegaly are therefore outlined in this review. Multidisciplinary assessment has important implications for the management of acromegaly, particularly in relation to cognitive function. Here, we summarize the relevant literature concerning cognitive-behavioral research on acromegaly to demonstrate the impact of long-term impairment caused by GH and IGF-1 on the cognitive behavior of patients.
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Hong S, Han K, Kim KS, Park CY. Risk of Neurodegenerative Diseases in Patients With Acromegaly: A Cohort Study. Neurology 2022; 99:e1875-e1885. [PMID: 36192177 DOI: 10.1212/wnl.0000000000201010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A few recent studies have reported an association between insulin-like growth factor-1 (IGF-1) and neurodegenerative disease, but there was no report on any association between acromegaly and neurodegenerative disease. We investigated whether the risk of Alzheimer disease (AD), Parkinson disease, and other neurodegenerative diseases was increased among patients with acromegaly using nationwide data of Korea. METHODS We studied the association between acromegaly and Parkinson disease and dementia in 1,611 patients with acromegaly and controls (age-matched and sex-matched 8,055 participants with no diagnosis of acromegaly) from the National Health Insurance System database between 2006 and 2016 with a mean follow-up period of 7.34 years. Cox proportional hazards regression analysis was used to assess the risk of all outcomes in patients with acromegaly compared with controls with adjusting for age, sex, household income, place, type 2 diabetes, hypertension, and dyslipidemia. RESULTS The average age of the patients with acromegaly and the controls was 54.16 years (40.4% men). The incidence rate of Parkinson disease in patients with acromegaly (1.54 per 1,000 person-years) was significantly higher than that in the control group (0.55 per 1,000 person-years) (log-rank test p = 0.001). Acromegaly was associated with a higher risk of Parkinson disease (hazard ratio [HR] = 2.609, 95% CI: 1.410-2.609) than the control. In addition, acromegaly was associated with a higher risk of all-cause dementia (HR = 2.299, 95% CI: 1.362-3.881), Alzheimer disease (HR = 2.228, 95% CI: 1.191-4.168), and non-AD dementia (HR = 6.553, 95% CI: 1.754-24.482) than the control during the first 3 years after diagnosis and treatment. In subgroup analysis, diabetes was associated with higher risk of all-cause dementia (P for interaction = 0.028) in patients with acromegaly compared with controls. DISCUSSION Our study results suggest that acromegaly is associated with neurodegenerative disease. Further study is needed on the association between IGF-1/growth hormone level and neurodegenerative disease.
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Affiliation(s)
- Sangmo Hong
- From the Department of Internal Medicine (S.H.), Guri Hospital, Hanyang University, College of Medicine; Department of Statistics and Actuarial Science (K.H.), Soongsil University, Seoul; Department of Internal Medicine (K.-S.K.), CHA Bundang Medical Center, CHA University School of Medicine, Seongnam; and Department of Internal Medicine (C.-Y.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- From the Department of Internal Medicine (S.H.), Guri Hospital, Hanyang University, College of Medicine; Department of Statistics and Actuarial Science (K.H.), Soongsil University, Seoul; Department of Internal Medicine (K.-S.K.), CHA Bundang Medical Center, CHA University School of Medicine, Seongnam; and Department of Internal Medicine (C.-Y.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Kim
- From the Department of Internal Medicine (S.H.), Guri Hospital, Hanyang University, College of Medicine; Department of Statistics and Actuarial Science (K.H.), Soongsil University, Seoul; Department of Internal Medicine (K.-S.K.), CHA Bundang Medical Center, CHA University School of Medicine, Seongnam; and Department of Internal Medicine (C.-Y.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- From the Department of Internal Medicine (S.H.), Guri Hospital, Hanyang University, College of Medicine; Department of Statistics and Actuarial Science (K.H.), Soongsil University, Seoul; Department of Internal Medicine (K.-S.K.), CHA Bundang Medical Center, CHA University School of Medicine, Seongnam; and Department of Internal Medicine (C.-Y.P.), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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4
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Gagliardi I, Chiloiro S, Vallillo M, Bondanelli M, Volpato S, Giampietro A, Bianchi A, De Marinis L, Zatelli MC, Ambrosio MR. Multidimensional geriatric evaluation in acromegaly: a comparative cross-sectional study. BMC Geriatr 2021; 21:598. [PMID: 34702173 PMCID: PMC8547074 DOI: 10.1186/s12877-021-02549-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background Improvement in acromegaly management increased disease survival and prevalence. Evidence regarding acromegaly in older adults are sparse. We aim to explore acromegaly impact on aging process quality. Methods Multicenter case-control study conducted on 42 older adults (≥ 65 years) acromegaly patients (ACRO) compared to an age- and gender-matched control group (CTR). Each participant underwent a multidimensional geriatric evaluation. Results Mean age in both groups was 73 ± 6 years and female gender was most represented (69%). All comorbidities were more frequent in ACRO than CTR. Thirteen ACRO were in remission and 29 had active disease controlled by medical therapy except for one patient. ACRO showed worse physical performance and mobility skills worsening with age as compared to CTR. ACRO performed poorly in functional status assessment, and age negatively correlated with instrumental and basic daily activities execution. Cognitive evaluation scores were significantly lower in ACRO vs. CTR, worsening with age. No difference was found concerning nutritional and psychological status. Musculoskeletal and bone diseases were more frequent in ACRO than in CTR (52% vs. 12%; 64% vs. 10%; P < 0.05) and independently associated with geriatric outcomes in ACRO. ACRO reported a less satisfactory quality of life concerning physical activity and pain, general health, vitality, social activities. Conclusions Our study demonstrates increased frailty of older acromegaly patients as compared to non-acromegaly patients with a consequent negative impact on their quality of life. Therefore, it seems advisable to include physical, functional, cognitive, nutritional, and psychological status assessments in routine clinical practice. Further studies are needed to identify the most appropriate geriatric tools.
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Affiliation(s)
- Irene Gagliardi
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Sabrina Chiloiro
- Department of Translational Medicine and Surgery, UOC Endocrinology and Diabetology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Vallillo
- Department of Translational Medicine and Surgery, UOC Endocrinology and Diabetology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Marta Bondanelli
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Stefano Volpato
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Antonella Giampietro
- Department of Translational Medicine and Surgery, UOC Endocrinology and Diabetology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Antonio Bianchi
- Department of Translational Medicine and Surgery, UOC Endocrinology and Diabetology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Laura De Marinis
- Department of Translational Medicine and Surgery, UOC Endocrinology and Diabetology, Fondazione A Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Section of Endocrinology, Geriatrics & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy.
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García-Casares N, Fernández-Andújar M, González-Molero I, Maraver-Selfa S, Gutiérrez-Bedmar M, Ramos-Rodriguez JR, Alfaro-Rubio F, Roé-Vellvé N, Garcia-Garcia I, García-Arnés JA. Cognitive Functioning and Cortical Brain Thickness in Acromegaly Patients: A Pilot study. Arch Clin Neuropsychol 2021; 36:780-790. [PMID: 33200172 DOI: 10.1093/arclin/acaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Cognitive effects in acromegaly patients are poorly understood and the mechanisms involved are still unclear. The aim of this study was to evaluate the cognitive function, depression, and quality of life of acromegaly patients treated with pegvisomant versus somatostatin analogues (SRLs) and to analyze the effect of the different treatments on cognition and possible structural brain changes. METHODS This cross-sectional study involved 23 acromegaly patients divided into two groups according to treatment modality: One group of 9 patients treated with pegvisomant and another group of 14 patients treated with SRLs. All participants underwent blood analysis, neuropsychological tests, depression tests, quality of life assessment, and 3-Tesla magnetic resonance imaging. RESULTS We found no significant differences between groups in the neuropsychological tests, depression or quality of life; nor in the whole-brain cortical thickness. In the SRL group, the volume of the thalamus correlated positively with executive function, a correlation not found in the pegvisomant group. In addition, the pegvisomant group had significantly higher levels of insulin than the SRL group. CONCLUSIONS In conclusion, in this pilot study, the type of pharmacological treatment in patients with acromegaly and good glycemic control did not influence the cognitive function and cortical brain thickness. However, pegvisomant could play a neuroprotective role on the thalamus that will have to be demonstrated with larger samples in future studies.
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Affiliation(s)
- Natalia García-Casares
- Department of Medicine, Faculty of Medicine, University of Malaga, Málaga, Spain.,Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain.,Área de Enfermedades cardiovasculares, obesidad y diabetes, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Marina Fernández-Andújar
- Universitat Abat Oliba CEU, CEU Universities, Facultad de Ciencias Sociales, Departamento Psicología
| | | | - Silvia Maraver-Selfa
- Department of Endocrinology, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - José R Ramos-Rodriguez
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Francisco Alfaro-Rubio
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Nuria Roé-Vellvé
- Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), University of Malaga, Málaga, Spain
| | - Isabel Garcia-Garcia
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Juan A García-Arnés
- Department of Endocrinology, Regional University Hospital of Malaga, Malaga, Spain.,Department of Pharmacology, Faculty of Medicine, University of Malaga, Malaga, Spain
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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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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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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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9
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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10
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Solomon E, Brănișteanu D, Dumbravă A, Solomon RG, Kiss L, Glod M, Preda C. Executive functioning and quality of life in acromegaly. Psychol Res Behav Manag 2019; 12:39-44. [PMID: 30655710 PMCID: PMC6322494 DOI: 10.2147/prbm.s183950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction Active acromegaly is a rare chronic endocrine disorder caused by excessive growth hormone (GH). Clinical studies suggest that cognitive performance is impaired in acromegaly – particularly executive function as well as short- and long-term memory. This study compared the quality of life (QoL) and executive functioning in acromegaly patients vs healthy controls. Materials and methods This was an observational case–control study on 38 subjects divided into 19 acromegaly patients and 19 matched controls. The groups were evaluated for QoL, attention, and executive function. All subjects completed Acromegaly Quality of Life Questionnaire (AcroQoL), Trail Making Test (parts A and B), Stroop, and phonemic fluency tests. Results Acromegaly patients had an AcroQoL global score that was significantly lower than controls. There were significant differences between the acromegaly group and the control group in terms of the physical effects (P=0.001) and appearance (P<0.001) but not for personal relationships (P=0.421). Acromegaly patients performed worse in the trail making test part B. They provided significantly fewer words than healthy subjects in phonemic fluency testing. Although patients performed generally worse than controls, no significant differences were noted in the trail making test part A, Stroop test, and the constrained phonemic fluency. Conclusion Acromegaly patients display worse executive functioning than healthy controls and have a decreased QoL.
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Affiliation(s)
- Emilia Solomon
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania, .,Department of Endocrinology, CF University Hospital, Iaşi, Romania
| | - Dumitru Brănișteanu
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania, .,Department of Endocrinology, "Sf. Spiridon" Hospital, Iaşi, Romania,
| | - Andrei Dumbravă
- Faculty of Psychology, Alexandru Ioan Cuza University, Iaşi, Romania
| | | | - Lorànt Kiss
- ISUD, Faculty of Medicine, University Lucian Blaga, Sibiu, Romania
| | - Mihai Glod
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania,
| | - Cristina Preda
- Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania, .,Department of Endocrinology, "Sf. Spiridon" Hospital, Iaşi, Romania,
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11
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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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12
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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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Alibas H, Uluc K, Kahraman Koytak P, Uygur MM, Tuncer N, Tanridag T, Gogas Yavuz D. Evaluation of depressive mood and cognitive functions in patients with acromegaly under somatostatin analogue therapy. J Endocrinol Invest 2017; 40:1365-1372. [PMID: 28660605 DOI: 10.1007/s40618-017-0722-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/23/2017] [Indexed: 01/05/2023]
Abstract
AIMS Acromegaly is caused by a pituitary adenoma that releases excess growth hormone (GH) and a concomitant increase in insulin-like growth factor 1 (IGF-1). Acromegaly results not only in phenotypic changes, but also in neurologic complications as peripheral neuropathy and cognitive dysfunction. This study aimed to compare depressive mood and cognitive function in patients with acromegaly and in healthy controls as well as to determine the factors underlying cognitive dysfunction in the acromegalic patients. MATERIALS AND METHODS This study included 42 patients with acromegaly that were receiving somatostatin analogue therapy and 44 healthy controls. Memory, attention, visuospatial function, inhibitory function, abstract thinking, verbal fluency, and depressive mood were measured in the patients and controls. RESULTS Patients with acromegaly had lower learning (p = 0.01), planning (p = 0.03), complex attention and inhibitory function (p = 0.04) scores than the controls. There was no significant difference in depressive mood between the patients and controls (p > 0.05). Gamma knife radiosurgery did not negatively affect cognitive function (p > 0.05). CONCLUSION The present findings show that acromegaly negatively affects learning, attention, and planning.
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Affiliation(s)
- H Alibas
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey.
| | - K Uluc
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - P Kahraman Koytak
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - M M Uygur
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, İc hastalıklari ABD, Endokrinoloji ve Metabolizma BD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - N Tuncer
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - T Tanridag
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Noroloji ABD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
| | - D Gogas Yavuz
- T.C. Saglik Bakanligi Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, İc hastalıklari ABD, Endokrinoloji ve Metabolizma BD, Fevzi Cakmak Mah. Muhsin Yazicioglu Cad. No: 10, Pendik, PK: 34899, Istanbul, Turkey
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Bobrov AE, Starostina EG, Alexandrova MM. [Mental disorders in patients with acromegaly]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:18-23. [PMID: 27735894 DOI: 10.17116/jnevro20161169118-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study mental disorders in acromegaly due to somatotropinoma. MATERIAL AND METHODS The study included 115 consecutively recruited patients with acromegaly (95 female and 20 male, aged from 21 to 78 years). Acromegaly was diagnosed by endocrinologists according to current guidelines based on clinical, laboratory data and brain MRI. All patients underwent a clinical psychiatric interview based on ICD-10 criteria. The Mini-Mental State Examination scale and Hypomania-Checklist (HCL-32) were used. RESULTS Mental disorders were diagnosed in 79.1% of patients. Organic spectrum disorders were found in 46.1%, bipolar spectrum disorders in 35.7%, schizophrenia spectrum disorders in 4.3%. The patients with bipolar spectrum disorders had significantly lower serum insulin-like growth factor 1 (IGF-1) levels compared to patients with organic spectrum disorders (p=0.01). The presence of organic spectrum disorders was associated with older age and number of somatic comorbidities (р=0.0001 and 0.001). CONCLUSION The prevalence of bipolar, organic and schizophrenia spectrum disorders in patients with acromegaly exceeds that in the general population. Significantly lower IGF-1 levels in acromegalic patients with bipolar disorders, compared to those with organic disorders, can have some implications to their pathogenesis.
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Affiliation(s)
- A E Bobrov
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - E G Starostina
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
| | - M M Alexandrova
- Pirogov Russian National Research University, Moscow, Russia, Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russia
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Grönbladh A, Nylander E, Hallberg M. The neurobiology and addiction potential of anabolic androgenic steroids and the effects of growth hormone. Brain Res Bull 2016; 126:127-137. [DOI: 10.1016/j.brainresbull.2016.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/30/2022]
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Haliloglu O, Dogangun B, Ozcabi B, Kural HU, Keskin FE, Ozkaya HM, Pamukcu FC, Bektas E, Poyraz BC, Buber H, Evliyaoglu O, Kadioglu P. General health status and intelligence scores of children of mothers with acromegaly do not differ from those of healthy mothers. Pituitary 2016; 19:391-8. [PMID: 27033692 DOI: 10.1007/s11102-016-0717-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the physical status and intelligence scores of children of acromegalic mothers and to compare them with those of children from mothers without acromegaly. METHODS Six women with acromegaly who became pregnant under follow-up between 2010 and 2014 and their 16 children (group A) were assessed and compared with 16 children of healthy women (group B) and 15 children of women with prolactinoma (group C). The physical examinations of children were performed by the department of pediatric endocrinology and intelligence quotient (IQ) testing was undertaken by adult and pediatric psychiatry departments, using appropriate scales for their ages. RESULTS Six of the 16 children (girls/boys: 7/9) were born after the diagnosis of acromegaly. Five of the 6 pregnancies occured when the patients were taking somatostatin analogs, none continued taking the drugs during pregnancy. The mean IQ of groups A, B, and C were 106.4 ± 12.5, 105.3 ± 12.5, and 103.2 ± 16.1 respectively (p > 0.05). The mean ages, birth percentiles, recent weight and height standard deviation scores were similar between groups (p > 0.05). Two siblings from group A and 1 child from group B were large for gestational age at birth. At recent follow-up, two children from group A were found tall for their age and one from group C was short for his age and was placed under the care of pediatric endocrinology clinic. CONCLUSIONS Pregnancies in acromegaly seems to be uneventful and the general health status and IQ scores of children from women with and without acromegaly were found similar.
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Affiliation(s)
- Ozlem Haliloglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burak Dogangun
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bahar Ozcabi
- Division of Endocrinology, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hanife Ugur Kural
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Ela Keskin
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Colkesen Pamukcu
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Elif Bektas
- Department of Pediatric Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burc Cagri Poyraz
- Department of Psychiatry, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hakan Buber
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Olcay Evliyaoglu
- Division of Endocrinology, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
- Pituitary Center, Istanbul University, Istanbul, Turkey.
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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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Abstract
Available disease-specific questionnaires like the Acromegaly Quality of Life questionnaire have confirmed that quality of life (QoL) is impaired in acromegaly, especially in active disease. Successful therapy improves QoL, but it may not normalize completely even after endocrine cure; furthermore, there is not always a correlation between growth hormone (GH) and insulin-like growth factor 1 and subjective health perception of QoL. Appearance is the dimension most affected and has the highest impact on the patient's QoL. Worse QoL is associated with the presence of musculoskeletal pain, headache (if only medical therapy, not surgery, has been provided), having required treatment with radiotherapy, being older, of female gender, with a longer disease duration, coexisting diabetes mellitus, a higher BMI or becoming GH deficient after treatment for acromegaly.
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Affiliation(s)
- Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigacix00F3;n Biomx00E9;dica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Barcelona, Spain
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Crespo I, Santos A, Valassi E, Pires P, Webb SM, Resmini E. Impaired decision making and delayed memory are related with anxiety and depressive symptoms in acromegaly. Endocrine 2015; 50:756-63. [PMID: 26018738 DOI: 10.1007/s12020-015-0634-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/14/2015] [Indexed: 11/25/2022]
Abstract
Evaluation of cognitive function in acromegaly has revealed contradictory findings; some studies report normal cognition in patients with long-term cured acromegaly, while others show attention and memory deficits. Moreover, the presence of affective disorders in these patients is common. Our aim was to evaluate memory and decision making in acromegalic patients and explore their relationship with affective disorders like anxiety and depressive symptoms. Thirty-one patients with acromegaly (mean age 49.5 ± 8.5 years, 14 females and 17 males) and thirty-one healthy controls participated in this study. The Iowa Gambling Task (IGT), Rey Auditory Verbal Learning Test, State-Trait Anxiety Inventory, and Beck Depression Inventory-II (BDI-II) were used to evaluate decision making, verbal memory, anxiety, and depressive symptoms, respectively. Acromegalic patients showed impairments in delayed verbal memory (p < 0.05) and more anxiety and depressive symptoms (p < 0.05) than controls. In the IGT, acromegalic patients presented an altered decision-making strategy compared to controls, choosing a lower number of the safer cards (p < 0.05) and higher number of the riskier cards (p < 0.05). Moreover, multiple correlations between anxiety and depressive symptoms and performance in memory and decision making were found. Impaired delayed memory and decision making observed in acromegalic patients are related to anxiety and depressive symptoms. Providing emotional support to the patients could improve their cognitive function. A key clinical application of this research is the finding that depressive symptoms and anxiety are essentially modifiable factors.
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Affiliation(s)
- Iris Crespo
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia Santos
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Valassi
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Patricia Pires
- INNDACYT, CR Laureà Miró, 107, Sant Feliu de Llobregat, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eugenia Resmini
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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20
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Pereira AM. Neuropsychological functioning in acromegaly: towards identification of modifiable factors to improve long-term care after remission. Endocrine 2015; 50:523-5. [PMID: 26349939 DOI: 10.1007/s12020-015-0736-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/25/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Alberto M Pereira
- Division of Endocrinology, Department of Medicine, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands.
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21
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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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Hatipoglu E, Yuruyen M, Keskin E, Yavuzer H, Niyazoglu M, Doventas A, Erdincler DS, Beger T, Kadioglu P, Gundogdu S. Acromegaly and aging: a comparative cross-sectional study. Growth Horm IGF Res 2015; 25:47-52. [PMID: 25547224 DOI: 10.1016/j.ghir.2014.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cognitive and functional geriatric assessment may change in acromegaly. Herein we aimed to determine at which points geriatric assessment of the cases with acromegaly differs from that of general elderly population. DESIGN In this comparative cross-sectional study, a total of 30 cases with acromegaly (controlled n = 14, uncontrolled n = 16) and 30 gender and body-mass index-matched cases without acromegaly (control group, CG) above 60 years old were included. Cognitive functions were evaluated on the basis of the mini-mental state exam (MMSE). Affective status was determined using the geriatric depression scale. Activities of daily living (ADL) were ranked according to the Barthel index while instrumental activities of daily living (IADL) were graded on the basis of the Lawton scale. Nutritional status was evaluated using the mini-nutritional assessment (MNA). Body composition was measured through bioimpedance analysis. Functional mobility was determined using the Timed Up and Go test (TUG) and muscle strength with the handgrip strength test. RESULTS Scores on the MMSE were significantly lower in the elderly cases with acromegaly than in the cases without acromegaly (p < 0.001). Dementia was more frequent in the acromegaly group than in the CG (p = 0.04). Total MNA scores were significantly lower in cases with acromegaly than in the CG (p = 0.006). More subjects in the acromegaly group (33%) were at greater risk of malnutrition than in the CG (3%) (p = 0.003). There was greater moderate functional impairment based on Barthel ADL in the acromegaly group than in the CG (p = 0.04). CONCLUSION Acromegaly may impair cognitive functions, functional mobility and instrumental daily living activities in the geriatric population. With acromegaly, the risk of malnutrition may also increase.
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Affiliation(s)
- Esra Hatipoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.
| | - Mehmet Yuruyen
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Ela Keskin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Mutlu Niyazoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Deniz Suna Erdincler
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Tanju Beger
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
| | - Sadi Gundogdu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey
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Crespo I, Webb SM. Perception of health and cognitive dysfunction in acromegaly patients. Endocrine 2014; 46:365-7. [PMID: 24664361 DOI: 10.1007/s12020-014-0236-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Iris Crespo
- Endocrinology/Medicine Departments, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII, IIB-Sant Pau, Pare Claret 167, 08025, Barcelona, Spain
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Yedinak CG, Fleseriu M. Self-perception of cognitive function among patients with active acromegaly, controlled acromegaly, and non-functional pituitary adenoma: a pilot study. Endocrine 2014; 46:585-93. [PMID: 24282035 DOI: 10.1007/s12020-013-0106-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
Abstract
Pituitary adenomas (PAs) represent 15 % of all brain tumors. One-sixth of these are reported to cause acromegaly via excess growth hormone secretion. These tumors have been associated with multiple comorbidities, including neuropsychiatric and cognitive dysfunction. We aimed to assess patient perception of cognitive deficits and the relationship of cognitive changes to active acromegaly (AA) versus controlled acromegaly (CA) versus non-functional PAs (NFPA). A modified FACT-Cog survey was used, which focused on the prevalence and severity of perceived dysfunction in five areas of cognitive function: ability to learn, concentration/distractibility, mental agility, memory and recall, and verbal recall. Patient perception of current health and health change over the previous 12 months was also assessed. The overall perceived prevalence and severity of cognitive dysfunction were the highest among NFPA groups, particularly in the areas of mental agility, verbal recall, and memory/recall. Patients with AA reported greater prevalence and severity of dysfunction with respect to concentration/distractibility and ability to learn. Patients with AA reported the best overall current health, though patients with CA reported the greatest improvement in health over the previous year. These findings may indicate that PAs can affect cognitive function regardless of whether excess growth hormone is present. Acromegaly and NFPA patients perceive specific areas of cognitive dysfunction that may require further evaluation and treatment. Further research may be useful regarding patient quality of life, patient functionality during normal daily activities, and perceived dysfunction despite biological disease control.
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Affiliation(s)
- Chris G Yedinak
- OHSU Northwest Pituitary Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd BTE472, Portland, OR, USA,
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Abstract
Emerging data indicate that growth hormone (GH) therapy could have a role in improving cognitive function. GH replacement therapy in experimental animals and human patients counteracts the dysfunction of many behaviours related to the central nervous system (CNS). Various behaviours, such as cognitive behaviours related to learning and memory, are known to be induced by GH; the hormone might interact with specific receptors located in areas of the CNS that are associated with the functional anatomy of these behaviours. GH is believed to affect excitatory circuits involved in synaptic plasticity, which alters cognitive capacity. GH also has a protective effect on the CNS, as indicated by its beneficial effects in patients with spinal cord injury. Data collected from animal models indicates that GH might also stimulate neurogenesis. This Review discusses the mechanisms underlying the interactions between GH and the CNS, and the data emerging from animal and human studies on the relationship between GH and cognitive function. In this article, particular emphasis is given to the role of GH as a treatment for patients with cognitive impairment resulting from deficiency of the hormone.
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Affiliation(s)
- Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, PO Box 591, S-751 24 Uppsala, Sweden
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Martín-Rodríguez JF, Madrazo-Atutxa A, Venegas-Moreno E, Benito-López P, Gálvez MÁ, Cano DA, Tinahones FJ, Torres-Vela E, Soto-Moreno A, Leal-Cerro A. Neurocognitive function in acromegaly after surgical resection of GH-secreting adenoma versus naïve acromegaly. PLoS One 2013; 8:e60041. [PMID: 23593161 PMCID: PMC3617159 DOI: 10.1371/journal.pone.0060041] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/20/2013] [Indexed: 11/18/2022] Open
Abstract
Patients with active untreated acromegaly show mild to moderate neurocognitive disorders that are associated to chronic exposure to growth hormone (GH) and insulin-like growth factor (IGF-I) hypersecretion. However, it is unknown whether these disorders improve after controlling GH/IGF-I hypersecretion. The aim of this study was to compare neurocognitive functions of patients who successfully underwent GH-secreting adenoma transsphenoidal surgery (cured patients) with patients with naive acromegaly. In addition, we wanted to determine the impact of different clinical and biochemical variables on neurocognitive status in patients with active disease and after long-term cure. A battery of six standardized neuropsychological tests assessed attention, memory and executive functioning. In addition, a quantitative electroencephalography with Low-Resolution Electromagnetic Tomography (LORETA) solution was performed to obtain information about the neurophysiological state of the patients. Neurocognitive data was compared to that of a healthy control group. Multiple linear regression analysis was also conducted using clinical and hormonal parameters to obtain a set of independent predictors of neurocognitive state before and after cure. Both groups of patients scored significantly poorer than the healthy controls on memory tests, especially those assessing visual and verbal recall. Patients with cured acromegaly did not obtain better cognitive measures than naïve patients. Furthermore memory deficits were associated with decreased beta activity in left medial temporal cortex in both groups of patients. Regression analysis showed longer duration of untreated acromegaly was associated with more severe neurocognitive complications, regardless of the diagnostic group, whereas GH levels at the time of assessment was related to neurocognitive outcome only in naïve patients. Longer duration of post-operative biochemical remission of acromegaly was associated with better neurocognitive state. Overall, this data suggests that the effects of chronic exposure to GH/IGF-I hypersecretion could have long-term effects on brain functions.
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Affiliation(s)
- Juan Francisco Martín-Rodríguez
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
| | - Ainara Madrazo-Atutxa
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
| | - Eva Venegas-Moreno
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
| | - Pedro Benito-López
- Division of Endocrinology, Hospital Universitario Reina Sofía, University of Córdoba, Córdoba, Spain
| | - María Ángeles Gálvez
- Division of Endocrinology, Hospital Universitario Reina Sofía, University of Córdoba, Córdoba, Spain
| | - David A. Cano
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
| | | | | | - Alfonso Soto-Moreno
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
| | - Alfonso Leal-Cerro
- Instituto de Biomedicina de Sevilla (IBiS), University Hospital Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville and Division of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain
- * E-mail:
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