Clinical characteristics of pain in patients with pituitary adenomas

Abstract

Objective: Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, due to structural and functional properties of the tumour. Our aim was to investigate the clinical characteristics of pain in a large cohort of patients with pituitary disease. Design: In a cross-sectional study, we assessed 278 patients with pituitary disease (nZ81 acromegaly; nZ45 Cushing's disease; nZ92 prolactinoma; nZ60 non-functioning pituitary adenoma). Methods: Pain was studied using validated questionnaires to screen for nociceptive vs neuropathic pain components (painDETECT), determine pain severity, quality, duration and location (German pain questionnaire) and to assess the impact of pain on disability (migraine disability assessment, MIDAS) and quality of life (QoL). Results: We recorded a high prevalence of bodily pain (nZ180, 65%) and headache (nZ178, 64%); adrenocorticotropic adenomas were most frequently associated with pain (nZ34, 76%). Headache was equally frequent in patients with macroand microadenomas (68 vs 60%; PZ0.266). According to painDETECT, the majority of the patients had a nociceptive pain component (nZ193, 80%). Despite high prevalence of headache, 72% reported little or no headache-related disability (MIDAS). Modifiable factors including tumour size, genetic predisposition, previous surgery, irradiation or medical therapy did not have significant impact neither on neuropathic pain components (painDETECT) nor on headache-related disability (MIDAS). Neuropathic pain and pain-related disability correlated significantly with depression and impaired QoL.Conclusions: Pain appears to be a frequent problem in pituitary disease. The data suggest that pain should be integrated in the diagnostic and therapeutic work-up of patients with pituitary disease in order to treat them appropriately and improve their QoL.

Quality of Life in Acromegaly

“…The exception, however, were the 3 patients in whom severe headache persisted, since their QoL did not improve, independently of their hormonal values after therapy [18]. In a further recent study, the presence of headache was also correlated with worse QoL but not with depression in acromegaly, while neuropathic pain determined both impaired QoL and depression [19]. …”

Neuropsychiatric and cardiometabolic comorbidities in patients with previously diagnosed Cushing's disease: a longitudinal observational study

“…Our research group has assessed 80 patients with CD in a cross-sectional setting. Results indicate that, in a cross-sectional observational study, patients with CD were shown to have a particularly high susceptibility to pain 21 and increased anxiety-associated personality traits. 22 This study will expand on these previous findings.…”

GEOFFREY HARRIS AWARD 2019: Translational research in pituitary tumours

“…We recorded a high prevalence of bodily pain (65%) and headache (64%); adrenocorticotropic adenomas were most frequently associated with pain (76%). Headache was equally frequent in patients with macro-and microadenomas (P = 0.266), while the majority of patients suffered from nociceptive pain (80%) (16).…”

“…The significant impact of chronic exposure to hypercortisolism on patient's health and healthrelated quality of life (HRQoL) has been demonstrated with generic questionnaires (17). The presence of pain and pain-related disability correlates significantly with impaired QoL in CD (16). All HRQoL parameters improve after treatment with TSS, however, even after long-term remission of CS, impaired QoL persists as a remaining effect of long-standing hypercortisolism, especially in the presence of hypopituitarism (18).…”

“…In the already mentioned study, we assessed 278 patients with pituitary diseases including 81 patients with acromegaly. Patients reported a high prevalence of bodily pain (65%) and headache (64%) correlating significantly with depression and impaired QoL (16).…”