Deteriorated Executive Functions in Patients with Successful Surgery for Pituitary Adenomas Compared with Other Chronically Ill Patients

Abstract

Pituitary adenomas, even after successful treatment, are associated with cognitive impairments. It is unclear whether these deficits are a consequence of unspecific factors associated with having a chronic illness and whether the cognitive dysfunctions exceed those of other chronically ill patients. Thirty-eight patients with transsphenoidal surgery for pituitary adenomas and 38 patients undergoing L-thyroxine replacement therapy after thyroid surgery were studied neuropsychologically with established tests. Executive function was examined with the Trail-Making Test A and B, working memory with the digit span test, attention with the digit symbol test, verbal memory with the German version of the Auditory Verbal Learning and Memory Test, and general verbal intelligence by a vocabulary test. Attention (p = .007), attentional speed (p = .0004), executive control (p = .04), and working memory (p = .01), were significantly reduced in patients with pituitary adenomas compared with other chronically ill patients. In contrast, no differences were found between the groups for verbal memory (all subtests: p ≥ .06). Patients with successful surgery for pituitary adenomas show also in comparison with other chronically ill patients an increased risk for deficits in certain aspects of cognitive function, including attention and working memory, supporting the relevance of the brain lesion and its treatment for these dysfunctions.

Current treatment protocols can offer a normal or near‐normal quality of life in the majority of patients with non‐functioning pituitary adenomas

“…Furthermore, compromised social and physical functioning, energy levels and emotional reactions, as well as increased anxiety, depression and fatigue have all been reported in women treated for microprolactinomas compared with controls . In pituitary adenomas, generally, including NFAs, cognitive defects including decreased attention, executive control, working memory, verbal memory and executive functioning have all been reported. More specifically, assessments by standardized personality questionnaires have revealed neurotic, harm‐avoidant personality patterns in patients with acromegaly and NFAs, reduced novelty seeking behaviour in patients with acromegaly, as well as less active coping strategies and increased avoidance behaviour in all subjects with pituitary adenomas …”

A Longitudinal, Prospective Study to Evaluate the Effects of Treatment on the Inhibitory Control Function After Transsphenoidal Surgery for Pituitary Adenomas

“…Inhibitory control impairment still exists after the surgery of pituitary adenoma, which is consistent with some points of previous studies. 22,23 This finding demonstrates that the inhibitory control function is impaired from brain injury or changes in neuroanatomical structures.…”

Neuropsychological functioning in acromegaly: towards identification of modifiable factors to improve long-term care after remission

“…At present, the number of reported patients that underwent neuropsychological evaluation after being considered adequately treated for acromegaly is still limited. Most studies evaluating cognitive function found worse scores on memory and executive functioning both in patients treated for acromegaly and for non-functioning adenomas, when compared to controls [10][11][12][13][14]. In the cohort of patients successfully treated for acromegaly at our center, cognitive function did not differ between acromegaly patients and matched controls or between acromegaly patients and patients treated for non-functioning adenomas [15].…”