Neurocognitive consequences of surgery and radiotherapy for tumours of the pituitary.

The management of patients with pituitary tumours requires a multidisciplinary approach utilizing a number of different treatment modalities that can impact upon pituitary function and may disrupt important areas of cerebral tissue that are important for normal neurocognitive function. Patients frequently report problems with memory and sustained attention that impact upon normal day-to-day life. At present it is unclear whether any causal link exists between treatments for pituitary tumours and abnormalities of memory and higher mental function. The domains of function affected in patients with pituitary tumours are memory and executive functions, which are involved in the control and direction of lower level, more automatic functions such as attention and motor skills. The evidence for disruption in these modalities is stronger for memory than for executive function. This may be due to variability in study design, insufficient tests and the potential inclusion of fundamentally different tumour types. The purpose of this review is to examine the available evidence to determine whether pituitary disease, its management, or subsequent complications are responsible for any neuropsychological deficits in pituitary patients. Furthermore we address methodological issues that may account for the apparent disparate neurocognitive data that exist in this patient group.

Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery.

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.

Neurocognitive changes in pituitary adenoma patients after gamma knife radiosurgery: a preliminary study.

OBJECTIVE: We evaluated the effects of gamma-knife radiosurgery (GKRS) on the cognitive functioning of patients with a pituitary adenoma. METHODS: A total of 14 patients with pituitary adenomas were enrolled in this neurocognitive study. Nine patients had Cushing disease, and five had nonfunctioning pituitary adenomas. Five patients underwent GKRS for their pituitary adenomas. Other treatment modalities included transsphenoidal resection and conservative management. Comparisons were made between treatment groups and between those with Cushing disease versus those with a nonfunctioning adenoma by the use of psychometric tests of general intellectual functioning, memory, and current mood state. These tests were the Symptom Checklist 90 Revised, Wechsler Test of Adult Reading, Wechsler Memory Scale-third edition, selected subtests of the Wechsler Adult Intelligence Scale-third edition, and the Delis-Kaplan Executive Function System. RESULTS: When analyzed collectively, the patient group showed deficits in immediate memory (t=-2.70, P=0.02) and high levels of psychological distress (46% of patients) in the presence of intact general intellectual functioning. No neurocognitive differences were found between the GKRS treated group versus participants not treated with GKRS (t≤0.70, P≥0.39). Similarly, no appreciable neurocognitive differences were demonstrated between those with nonfunctioning adenomas as compared with those with Cushing disease (t≤1.56, P≥0.15). CONCLUSIONS: We found no evidence that GKRS impairs the neurocognitive functioning of patients with pituitary disease above any impairment caused by the disease itself. Further studies will require approximately 20 patients in each comparison group to confirm this result.