Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication

Peace,; Orme,; Padayatty,; Godfrey,; Belchetz,

doi:10.1046/j.1365-2265.1998.00543.x

Cited by 75 publications

(88 citation statements)

References 13 publications

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“…In patients with adult-onset GHD, the data are less consistent; the presence/severity of cognitive deficits seems to be determined by underlying cause and its treatment (23)(24)(25). Subjects with large tumours, such as craniopharyngiomas requiring transfrontal surgery, have lower cognitive function than subjects requiring medical treatment only.…”

Section: Discussionmentioning

confidence: 87%

“…Subjects with large tumours, such as craniopharyngiomas requiring transfrontal surgery, have lower cognitive function than subjects requiring medical treatment only. However, suboptimal cognition has been found also in patients who had not been treated with surgery or radiotherapy (23), raising the possibility that hormonal abnormalities per se could be responsible. Another aspect for consideration is the duration of GHD, which is generally longer in patients with childhood-onset disease.…”

Section: Discussionmentioning

confidence: 99%

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Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12-month study

et al. 2007

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Objective: Young adults with childhood-onset GH deficiency (GHD) have reduced memory and attention, which can be improved by treatment with GH. Little information is available on cognitive function in elderly GHD patients. Design: Single center, double-blind, randomized, placebo-controlled study of 52-week duration. Methods: Elderly GH therapy naïve GHD patients (nZ34; age range 60-77 years) were enrolled and randomized to receive placebo or GH therapy which was titrated to achieve a target IGF-I level of C1 to C2 S.D. of the normal mean for age. Cognitive function was assessed at baseline and after 24 and 52 weeks, using a computerized psychometric test package (Neurobehavioral Examination System-2). Results: The mean GH dose was 0.16G0.06 mg/day; mean IGF-I increased from 135G59 ng/ml at baseline to 213G77 ng/ml during active treatment. The GH-treated group had better mean serial digit learning scores compared with placebo group (P!0.05). Assessment of effect sizes showed that improvements in memory occurred with GH after 24 weeks. The overall adverse event rates were similar in the GH and the placebo group. Conclusion: This study indicates that GH replacement may be accompanied by improvement in certain measures of cognitive function in elderly patients with GHD.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12-month study

et al. 2007

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“…Both have been associated with cognitive impairments in memory, attention/concentration (working memory), and information processing speed. (Baum et al, 1998;Deijen et al, 1996;Lijffijt et al, 2003;Peace et al, 1998;van Dam et al, 2005). Replacement of GH in persons with childhood-onset GHD has shown improvement in these cognitive domains (Arwert et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Effect of Growth Hormone Replacement Therapy on Cognition after Traumatic Brain Injury

High

Briones-Galang

Clark

et al. 2010

Journal of Neurotrauma

143

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Traumatic brain injury (TBI) is a major public health issue, and yet medical science has little to offer for the persistent symptoms that prevent many of these individuals from fully re-entering society. Post-traumatic hypopituitarism, and specifically growth hormone deficiency (GHD), has been found in a large percentage of individuals with chronic moderate to severe TBI. Presently, there are no published treatment studies of hormone replacement in this population. In this study, 83 subjects with chronic TBI were screened for hypopituitarism. Forty-two subjects were found to have either GHD or GH insufficiency (GHI), of which 23 agreed to be randomized to either a year of GH replacement or placebo. All subjects completed the study with no untoward side effects from treatment. A battery of neuropsychological tests and functional measures were administered before and after treatment. Improvement was seen on the following tests: Dominant Hand Finger Tapping Test, Wechsler Adult Intelligence Scale III-Information Processing Speed Index, California Verbal Learning Test II, and the Wisconsin Card Sorting Test (executive functioning). The findings of this pilot study provide preliminary evidence suggesting that some of the cognitive impairments observed in persons who are GHD/GHI after TBI may be partially reversible with appropriate GH replacement therapy.

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“…However, we (13) and others (14,15,16,17) did not find an effect of RT on the cognitive performance of patients treated for pituitary disease.…”

Section: Introductionmentioning

confidence: 98%

Cognitive performance after postoperative pituitary radiotherapy: a dosimetric study of the hippocampus and the prefrontal cortex

Brummelman

Sattler²,

Meiners³

et al. 2012

European Journal of Endocrinology

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Objective: The hippocampus and prefrontal cortex (PFC) are important for memory and executive functioning and are known to be sensitive to radiotherapy (RT). Radiation dosimetry relates radiation exposure to specific brain areas. The effects of various pituitary RT techniques were studied by relating detailed dosimetry of the hippocampus and PFC to cognitive performance. Methods: In this cross-sectional design, 75 non-functioning pituitary macroadenoma (NFA) patients (61G10 years) participated and were divided into irradiated (RTC, nZ30) and non-irradiated (RTK, nZ45) groups. The RTC group (who all received 25 fractions of 1.8 Gy; total dose: 45 Gy) consisted of three RT technique groups: three-field technique, nZ10; four-field technique, nZ15; and five-field technique, nZ5. Memory and executive functioning were assessed by standardized neuropsychological tests. A reconstruction of the dose distributions for the three RT techniques was made. The RT doses on 30, 50, and 70% of the volume of the left and right hippocampus and PFC were calculated. Results: Cognitive test performance was not different between the four groups, despite differences in radiation doses applied to the hippocampi and PFC. Age at RT, time since RT, and the use of thyroid hormone varied significantly between the groups; however, they were not related to cognitive performance. Conclusion: This study showed that there were no significant differences on cognitive performance between the three-, four-, and five-field RT groups and the non-irradiated patient group. A doseresponse relationship could not be established, even with a radiation dose that was higher on most of the volume of the hippocampus and PFC in case of a four-field RT technique compared with the three-and five-field RT techniques.

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Cognitive dysfunction in patients with pituitary tumour who have been treated with transfrontal or transsphenoidal surgery or medication

Abstract: Many patients with treated pituitary tumour suffer significant cognitive impairment. The severity and nature of impairment differs between treatment groups, although the cause of this could not be addressed by this study. Recommendations are made for future research and clinical practice.

Cited by 75 publications

References 13 publications

Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12-month study

Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12-month study

Effect of Growth Hormone Replacement Therapy on Cognition after Traumatic Brain Injury

Cognitive performance after postoperative pituitary radiotherapy: a dosimetric study of the hippocampus and the prefrontal cortex

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