Quality of Life but not Cognition is Impacted by Radiotherapy in Patients with Non-Functioning Pituitary Adenoma

Abstract

Non-functioning pituitary adenomas (NFPA) are benign neoplasms that are first treated by surgery and secondary radiation therapy in case of residual tumor or regrowth. The consequences of surgery and radiotherapy are still debated. The objective of the work was to assess the impact of surgery, radiotherapy (RT) and pituitary deficiencies on long term health-related quality of life (QoL) and cognitive function among NFPA patients. Forty-six NFPA patients were studied after 9.6±7.5 years follow-up using: i) the MoCA questionnaire to detect mild cognitive disabilities, ii) the McNair and Kahn scale to assess perceived cognitive impairment, iii) the HADS questionnaire to score anxiety and depression, and iv) the SF-36 and QLS-H questionnaires to assess QoL. All NFPA patients had surgery and 54% patients had radiation therapy (RT+). The MoCA score was abnormal in 41% NFPA patients. Neither the type of surgery nor radiotherapy influenced the prevalence of cognitive disabilities. The depression score was higher in RT+than RT– patients. Overall, no alteration in SF-36 and QLS-H QoL scales were observed in NFPA patients when compared with the French reference population. Among NFPA patients, mental composite score, general health and vitality scores were altered in RT+compared to RT– patients. The presence of multiple pituitary axis deficiencies worsened general health and vitality scale scoring. Consistent follow-up had a beneficial impact on psycho-emotional dimensions of health. Surgery and radiotherapy had no adverse effects on cognitive functions, however, QoL was altered in RT+patients. These latter alterations may be partly related to pituitary hormone deficiencies.

Lack of delayed neurocognitive side effects of Gamma Knife radiosurgery in acromegaly: the Later-Ac study

“…In contrast, Crouzeix et al, in a study based on 46 patients followed for almost 10 years, reported that patients treated with radiotherapy for non functioning pituitary adenoma (NFPA) did not present with cognitive deficits but did show altered quality of life. However, they also suggested that this might be due to a higher rate of pituitary deficiencies rather than to the radiotherapy itself (31). To our knowledge, only one retrospective cross-sectional study has evaluated the cognitive effects of GK in patients treated for a pituitary adenoma.…”

The fatigue, sleep and physical activity in postoperative patients with pituitary adenoma: what we can do

“…The goal for PA treatment is to eliminate tumor compression, protect nerve function, restore hormone and metabolic order ( 23 ). Numerous studies ( 16 , 24 , 25 ) have reported that PA patients have symptoms such as fatigue, infertility, daytime sleepiness, sleep disturbance, depression and anxiety, etc., which often persist even after PA resection. The complications and high recurrence rate of PA have caused major blows to patients, and patients often cannot adapt properly ( 26 ).…”

Progressive resistance exercise in patients with pituitary adenoma: it does work

“…Fatigue will appear in patients after surgery and will persist for several months [7]. In some patients, sleepiness and fatigue will last for several years or even longer, which seriously affects the quality of life of patients and is not conducive to their return to the work and life [8,9].…”