COGNITIVE DYSFUNCTION IN PATIENTS WITH PITUITARY-TUMOR WHO HAVE BEEN TREATED WITH TRANSFRONTAL OR TRANSSPHENOIDAL SURGERY OR MEDICATION

OBJECTIVE This study was carried out to examine the neuropsychological status of patients treated for pituitary tumour by transfrontal surge ry, transphenoidal surgery or medical treatment only, with or without radiotherapy, DESIGN AND MEASUREMENTS Three groups of 23 patients who had been treated for pituitary tumour were compared with 23 healthy co ntrols on a range of neuropsychological measures. The surgical patient s were also subdivided into two groups and compared. The neuropsycholo gical measures were standardized psychological tests designed to asses s aspects of attention, memory and executive function,PATIENTS The pat ients were those who had been treated with transfrontal surgery (n = 2 3), transsphenoidal surgery (n= 23) and medication only (n = 23), The groups did not differ with respect to age, education or premorbid abil ity level as assessed by the National Adult Reading Test. All particip ants were free of known sources of cognitive impairment other than pit uitary tumour. RESULTS Comparison of the four groups revealed that nea rly half of the transfrontal, one-third of the transsphenoidal and one -quarter of the non-surgical group had three or more neuropsychologica l tests scores below the 10th percentile compared to less than 5% of t he controls, Impairments in memory and executive function were found i n both surgical groups. The non-surgical patients appeared to have pro blems only on tasks requiring high levels of cognitive processing. Dif ferences were found between the two surgical groups with respect to th e severity of the cognitive impairment, the transfrontal patients havi ng more severe impairment than the transsphenoidal, No significant neg ative effects on cognitive functioning were associated with radiothera py; however, transfrontal surgery patients who had not been treated wi th radiotherapy were found to be more impaired than other patients, Th is was thought to be related to radical surgery. CONCLUSIONS Many pati ents with treated pituitary tumour suffer significant cognitive impair ment. The severity and nature of impairment differs between treatment groups, although the cause of this could not be addressed by this stud y. Recommendations are made for future research and clinical practice.