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

Published online by Cambridge University Press:  21 December 2010

Karsten Müssig*
Affiliation:
Division of Endocrinology, Diabetes, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen, Tübingen, Germany Department of Internal Medicine, Gastroenterology and Oncology, Florence Nightingale Hospital, Kaiserswerther Diakonie, Düsseldorf, Germany
Britta Besemer
Affiliation:
Division of Endocrinology, Diabetes, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen, Tübingen, Germany
Ralf Saur
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
Stefan Klingberg
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
Hans-Ulrich Häring
Affiliation:
Division of Endocrinology, Diabetes, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen, Tübingen, Germany
Baptist Gallwitz
Affiliation:
Division of Endocrinology, Diabetes, Angiology, Nephrology and Clinical Chemistry, Department of Internal Medicine, University Hospital of Tübingen, Tübingen, Germany
Thomas Leyhe
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany Geriatric Center at the University Hospital of Tübingen, Tübingen, Germany
*
Correspondence and reprint requests to: Karsten Müssig, MD, Klinik für Innere Medizin mit Gastroenterologie und Onkologie, Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Kreuzbergstr. 79, 40489 Düsseldorf, Germany. E-mail: [email protected]

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. (JINS, 2011, 17, 369–375)

Type
Brief Communication
Copyright
Copyright © The International Neuropsychological Society 2010

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References

REFERENCES

Armstrong, C.L., Hunter, J.V., Ledakis, G.E., Cohen, B., Tallent, E.M., Goldstein, B.H., Phillips, P. (2002). Late cognitive and radiographic changes related to radiotherapy: Initial prospective findings. Neurology, 59, 4048.CrossRefGoogle ScholarPubMed
Aron, D.C., Howlett, T.A. (2000). Pituitary incidentalomas. Endocrinology and Metabolism Clinics of North America, 29, 205221.CrossRefGoogle ScholarPubMed
Attree, E.A., Dancey, C.P., Keeling, D., Wilson, C. (2003). Cognitive function in people with chronic illness: Inflammatory bowel disease and irritable bowel syndrome. Applied Neuropsychology, 10, 96104.CrossRefGoogle ScholarPubMed
Chanson, P., Salenave, S. (2004). Diagnosis and treatment of pituitary adenomas. Minerva Endocrinologica, 29, 241275.Google ScholarPubMed
Dorn, L.D., Burgess, E.S., Dubbert, B., Simpson, S.E., Friedman, T., Chrousos, G.P. (1995). Psychopathology in patients with endogenous Cushing's syndrome: ‘Atypical’ or melancholic features. Clinical Endocrinology, 43, 433442.CrossRefGoogle ScholarPubMed
Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L., McCutcheon, I.E. (2004). The prevalence of pituitary adenomas: A systematic review. Cancer, 101, 613619.CrossRefGoogle ScholarPubMed
Franke, G.H. (2002). Symptom-Checkliste von L.R. Derogatis – Deutsche Version (SCL-90-R). Göttingen: Beltz Test GmbH.Google Scholar
Grattan-Smith, P.J., Morris, J.G., Shores, E.A., Batchelor, J., Sparks, R.S. (1992). Neuropsychological abnormalities in patients with pituitary tumours. Acta Neurologica Scandinavica, 86, 626631.CrossRefGoogle ScholarPubMed
Guinan, E.M., Lowy, C., Stanhope, N., Lewis, P.D., Kopelman, M.D. (1998). Cognitive effects of pituitary tumours and their treatments: Two case studies and an investigation of 90 patients. Journal of Neurology, Neurosurgery, and Psychiatry, 65, 870876.CrossRefGoogle Scholar
Hailpern, S.M., Melamed, M.L., Cohen, H.W., Hostetter, T.H. (2007). Moderate chronic kidney disease and cognitive function in adults 20 to 59 years of age: Third National Health and Nutrition Examination Survey (NHANES III). Journal of the American Society of Nephrology, 18, 22052213.CrossRefGoogle ScholarPubMed
Helmstaedter, C., Lendt, M., Lux, S. (2001). VLMT Verbaler Lern- und Merkfähigkeitstest. Göttingen: Beltz Test GmbH.Google Scholar
Jurado, M.B., Rosselli, M. (2007). The elusive nature of executive functions: A review of our current understanding. Neuropsychology Review, 17, 213233.CrossRefGoogle ScholarPubMed
Knudsen, E.I. (2007). Fundamental components of attention. Annual Review of Neuroscience, 30, 5778.CrossRefGoogle ScholarPubMed
Kuratsu, J., Ushio, Y. (1997). Epidemiological study of primary intracranial tumours in elderly people. Journal of Neurology, Neurosurgery, and Psychiatry, 63, 116118.CrossRefGoogle ScholarPubMed
Leh, S.E., Petrides, M., Strafella, A.P. (2010). The neural circuitry of executive functions in healthy subjects and Parkinson's disease. Neuropsychopharmacology, 35, 7085.CrossRefGoogle ScholarPubMed
Lehrl, S. (2005). Mehrfachwahl-Wortschatz-Intelligenztest (5th ed). Erlangen: perimed Fachbuchgesellschaft.Google Scholar
Leyhe, T., Müssig, K., Weinert, C., Laske, C., Häring, H.U., Saur, R., Gallwitz, B. (2008). Increased occurrence of weaknesses in attention testing in patients with Hashimoto's thyroiditis compared to patients with other thyroid illnesses. Psychoneuroendocrinology, 33, 14321436.CrossRefGoogle ScholarPubMed
Mindermann, T., Wilson, C.B. (1994). Age-related and gender-related occurrence of pituitary adenomas. Clinical Endocrinology, 41, 359364.CrossRefGoogle ScholarPubMed
Müssig, K., Leyhe, T., Besemer, B., Saur, R., Häring, H.U., Gallwitz, B., Klingberg, S. (2009). Younger age is a good predictor of better executive function after surgery for pituitary adenoma in adults. Journal of the International Neuropsychological Society, 15, 803806.CrossRefGoogle ScholarPubMed
Peace, K.A., Orme, S.M., Padayatty, S.J., Godfrey, H.P., Belchetz, P.E. (1998). Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication. Clinical Endocrinology, 49, 391396.CrossRefGoogle ScholarPubMed
Peace, K.A., Orme, S.M., Thompson, A.R., Padayatty, S., Ellis, A.W., Belchetz, P.E. (1997). Cognitive dysfunction in patients treated for pituitary tumours. Journal of Clinical and Experimental Neuropsychology, 19, 16.CrossRefGoogle ScholarPubMed
Reitan, R. (1992). Trail making Test. Manual for Administration and Scoring. Arizona: Reitan Neuropsychology Laboratory.Google Scholar
Rosilio, M., Blum, W.F., Edwards, D.J., Shavrikova, E.P., Valle, D., Lamberts, S.W., Attanasio, A.F. (2004). Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). The Journal of Clinical Endocrinology and Metabolism, 89, 16841693.CrossRefGoogle ScholarPubMed
Saravanan, P., Chau, W.F., Roberts, N., Vedhara, K., Greenwood, R., Dayan, C.M. (2002). Psychological well-being in patients on ‘adequate’ doses of l-thyroxine: Results of a large, controlled community-based questionnaire study. Clinical Endocrinology, 57, 577585.CrossRefGoogle ScholarPubMed
Starkman, M.N., Schteingart, D.E. (1981). Neuropsychiatric manifestations of patients with Cushing's syndrome. Relationship to cortisol and adrenocorticotropic hormone levels. Archives of Internal Medicine,, 141, 215219.CrossRefGoogle ScholarPubMed
Surawicz, T.S., McCarthy, B.J., Kupelian, V., Jukich, P.J., Bruner, J.M., Davis, F.G. (1999). Descriptive epidemiology of primary brain and CNS tumors: Results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro-Oncology, 1, 1425.Google ScholarPubMed
Tewes, U. (1999). HAWIE: Hamburg-Wechsler Intelligenztest für Erwachsene, Revision. Bern: Huber.Google Scholar
Tooze, A., Gittoes, N.J., Jones, C.A., Toogood, A.A. (2009). Neurocognitive consequences of surgery and radiotherapy for tumours of the pituitary. Clinical Endocrinology, 70, 503511.CrossRefGoogle ScholarPubMed
Torres, I.J., Mundt, A.J., Sweeney, P.J., Llanes-Macy, S., Dunaway, L., Castillo, M., Macdonald, R.L. (2003). A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neurology, 60, 11131118.CrossRefGoogle ScholarPubMed
von Ammon, C.S., Wettstein, R.M. (1989). Emotional and cognitive dysfunction associated with medical disorders. Journal of Psychosomatic Research, 33, 505514.Google Scholar
Walker, M.D., McMahon, D.J., Inabnet, W.B., Lazar, R.M., Brown, I., Vardy, S., Silverberg, S.J. (2009). Neuropsychological features in primary hyperparathyroidism: A prospective study. The Journal of Clinical Endocrinology and Metabolism, 94, 19511958.CrossRefGoogle ScholarPubMed
Wekking, E.M., Appelhof, B.C., Fliers, E., Schene, A.H., Huyser, J., Tijssen, J.G., Wiersinga, W.M. (2005). Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. European Journal of Endocrinology, 153, 747753.CrossRefGoogle ScholarPubMed