Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery.
J Neurosurg
; 129(Suppl1): 55-62, 2018 12 01.
Article
em En
| MEDLINE
| ID: mdl-30544290
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.
Palavras-chave
ACTH = adrenocorticotropic hormone; AMI = Auditory Memory Index; Cushing's; D-KEFS = Delis-Kaplan Executive Function System; DMI = Delayed Memory Index; FSIQ = Full Scale Intelligence Quotient; GH = growth hormone; GKRS = Gamma Knife radiosurgery; IMI = Immediate Memory Index; NFA = nonfunctioning adenoma; SHBG = sex hormonebinding globulin; T4 = thyroxine; TSH = thyroid-stimulating hormone; VMI = Visual Memory Index; VWMI = Visual Working Memory Index; WAIS-IV = Wechsler Adult Intelligence ScaleFourth Edition; WMS-IV = Wechsler Memory ScaleFourth Edition; cognitive function; memory; nonfunctioning adenoma; stereotactic radiosurgery
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Hipofisárias
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Adenoma
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Radiocirurgia
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prevalence_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Neurosurg
Ano de publicação:
2018
Tipo de documento:
Article