Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma

Pereira-Neto, Aldo; Borba, André Meireles; Mello, Paulo Andrade de; Naves, Luciana Ansaneli; Araújo, António; Casulari, Luis Augusto

doi:10.1590/s0004-282x2010000300004

Cited by 24 publications

(21 citation statements)

References 20 publications

(34 reference statements)

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“…20 Similarly, this study has found that preoperative headache severity is significantly associated with reduced scores across all SF-36 QOL dimensions, including mental health and general health. These results are intuitive in that patients with the greatest headache severity would suffer the greatest impact of the pain on their daily life and limitations in their individual capabilities.…”

Section: Discussionsupporting

confidence: 54%

Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Wolf¹,

Goncalves²,

Salehi³

et al. 2016

JNS

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Pituitary tumors are relatively common, with reported prevalence rates ranging from 10% to 22% and accounting for 10% to 15% of all intracranial tumors. 3,5,22 With the advent of neuroimaging, the incidental finding of pituitary adenoma has become much more frequent. Chronic headache is a common reason for undergoing neuroimaging. The incidence of headache in patients with pituitary adenomas has been reported to range between 33% and 72%. 1,6,23 The existence of any clear relationship between headaches, pituitary tumors, and surgical treatment of pituitary tumors remains to be elucidated. Chronic headache in patients with pituitary tumors may arise from several putative mechanisms, including tumor volume and its relationship with the sellar structures, functional disturbance within the hypothalamopituitary axis, patient predisposition, and family history. 8,9 Invasion of the cavernous sinus is a proposed etiology of headache given that the sinus contains the ophthalmic branch of obJective The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). methods In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. results Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. coNclusioNs The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

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Section: Discussionsupporting

confidence: 54%

Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Wolf¹,

Goncalves²,

Salehi³

et al. 2016

JNS

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“…Several studies have recorded intrasellar pressure in the operating room and reported it to be higher in patients with headache [23][24][25][26]. Validation of this metric as a way of attributing the headache to sellar or parasellar pathology will require confirmation that intrasellar pressure is particularly elevated in patients with postoperative improvement in headache.…”

Section: Discussionmentioning

confidence: 99%

Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement

Jahangiri

Wagner

Chin

et al. 2015

Clinical Neurology and Neurosurgery

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“…In another prospective study by Levy and colleagues, 63 patients initially seen with pituitary tumours were evaluated for headache which was present in 70%, whereas Pereira‐Neto et al . found moderate to severe headache, graded by means of the Headache Impact Test Scale (HIT‐6) in 68% (17/25 patients) consecutive patients undergoing surgery for pituitary adenomas . Gondim and colleagues assessed the presence of headache and headache characteristics (by means of a self‐made questionnaire) in 64 prospective patients with a primary pituitary mass .…”

Section: Prevalence and Clinical Characteristics Of Headache In Pituimentioning

confidence: 99%

“…An increase in tumour size may raise the intrasellar pressure (ISP) . Even though ISP measurements are not available in healthy persons, ‘normal’ ISP was defined in patients with small microadenomas or in patients with empty sella .…”

Section: Pathophysiology Of Headache In Pituitary Diseasementioning

confidence: 99%

Headache and pituitary disease: a systematic review

Kreitschmann-Andermahr

Siegel

Carneiro

et al. 2013

Clinical Endocrinology

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Summary Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus invasion, traction or displacement of intracranial pain‐sensitive structures such as blood vessels, cranial nerves and dura mater, and hormonal hypersecretion are implicated causes. The present review attempts to systematically review the literature for any combination of headache and pituitary or hormone overproduction or deficiency. Most data available are retrospective and/or not based on the International Headache Society (IHS) classification. Whereas in pituitary apoplexy a mechanical component explains the almost universal association of the condition with headaches, this correlation is less clear in other forms of pituitary disease and a positive impact of surgery on headaches is not guaranteed. Similarly, invasion into the cavernous sinus or local inflammatory changes have been linked to headaches without convincing evidence. Some studies suggest that oversecretion of GH and prolactin may be important for the development of headaches, and treatment, particularly with somatostatin analogues, has been shown to improve symptoms in these patients. Otherwise, treatment rests on general treatment options for headaches based on an accurate clinical history and a precise classification which includes assessment of the patient's psychosocial risk factors.

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Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma

Cited by 24 publications

References 20 publications

Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement

Headache and pituitary disease: a systematic review

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