Neurobehavioral Functioning of Adults with Pituitary Disease

Abstract

Neurobehavioral disorders are not infrequent in adults with pituitary disease. The disorders can be due to compression of brain structures important for cognitive and emotional function, effects of hormonal imbalance on sensitive structures, post-surgical disruption of connecting pathways, adverse reactions to medical therapy, and adverse delayed effects of radiation therapy. A multidisciplinary team approach to the treatment of pituitary tumors will allow for the early diagnosis of neurobehavioral disorders and the institution of pharmacologic and behavioral interventions.

Executive functions recover earlier than episodic memory after microsurgical transsphenoidal resection of pituitary tumors in adult patients – a longitudinal study

“…The effects of tumor compression on the third ventricle and diencephalic structures has been described previously and even amnestic syndromes in patients harbouring large adenomas with suprasellar extension and invasion of the diencephalon as part of the clinical spectrum have been reported. 5,23 In patients with non-functioning adenomas, we could show clearly in the multivariate analyses that improvement of overall concentration, as shown by psychomotor speed, could be best explained by successful removal of the suprasellar portion of the tumor. This finding applied to not only patients with non-functioning adenomas, but also to patients harbouring prolactinomas or other sellar lesions.…”

“…Therefore, we assume that patients harbouring macroadenomas with suprasellar tumor extension, either functioning or not, profit from the decompression of adjacent neuroanatomical structures. 5,23 In patients with acromegaly, improvements in concentration performance and psychomotor speed were not correlated with the preoperative suprasellar extension. However, only 37% of patients with acromegaly presented with an initial suprasellar tumor extension.…”

“…[1][2][3] Many factors contribute to these findings, including hormonal imbalance or mass effect of the tumor on adjacent neuroanatomical structures. 4,5 It is assumed that undisturbed production and physiological availability of corticosteroids is essential for interpreting, learning and storing new information. 6 Longitudinal studies that have assessed the neurocognitive performance of patients with pituitary adenomas have focused only on patients with Cushing's disease, and revealed that most of the cognitive domains investigated, especially attentional tasks, did not improve within the observation period.…”

Psychological Stress and Neuroendocrine Function in Humans: The Last Two Decades of Research

“…To obtain an actual advancement of psychosomatic and psychiatric research, overcoming the rigid dichotomy between psychological and biological processes is mandatory [202]. In the same way, significant progress in the understanding of endocrine diseases requires endorsement of a biopsychosocial approach [203, 204, 205, 206, 207, 208, 209, 210]. …”

Attention in Adult Intracranial Tumors Patients

“…Although there were cognitive differences between both pituitary groups and controls, there were no differences between the irradiated and nonirradiated groups. Additional studies (Meyers, 1998;Peace et al, 1997) identified memory and executive impairments from the effects of pituitary tumors, and attributed these impairments to radiation therapy, hormone imbalance, and surgery. Rarely have other deep tumor studies, specifically meningiomas in the falx or cavernous sinus, found neuropsychological effects (Ledakis, Jo, Armstrong, & Hunter, submitted).…”