The Clinical Study On Cognitive Function In Patients With Pituitary Adenoma

Objective:To study cognitive status and impact factors of patients with pituitary adenomasMethods: 89 cases of patients were enrolled into our study,who were dignosed of pituitary adenoma(PA)with pathological evidence from December 2014 to February2016.As the normal control(NC),one family member or friend of the recruited patiend with matched age,gender,andeducation background,was also recruited with consent.Patients' s characteristic datas were collected,include: age,gender,education,clinical manifestation,course of disease(starting from occurrence of related symptoms and signs in patients chief complaint,tumor size(in mm,based on MRI report),and eyesight(examination from ophthalmology).After overnight fastening,on the morning of the second day after admission,blood sample were collected from patients for hormonal tests,including cortisol,growth hormone(GH),prolactin(PRL),adenocorticotropic,hormone(ACTH),Thyr-oxine(T3 and T4),thyrotropin(TSH),estradiol,testosterone,follicle stimulating hormone(FSH),and luteinizing hormone(LH).On the same daycognitive evaluation was conducted to obtain the cognitive function scores with CAMCOG-C and MMSE.The data were Analyzed using SPSS16.0 with the assistance from the statistics department of Anhui Medical University.Results:(1)The cases were divied into functioning pituitary adenoma group(FPA)(n=38)and non-functioning pituitary adenoma group(NFA)(n=51)according to the hormonal tests,clinical manifestation and pathological evidence.(2)The scores of MMSE,CAMCOG-C total,orientation,language,comprehension,expression,memory,remote,recent,recall,attention,praxis,abstract thinking,calculation perception of the PA group were statistical lower than the NC group(P <0.05).(3)No score of cognitive functions was statistical correlated with tumors diameter,except for perception,which was negatively correlated with cognitive impairment(Spearmans R=-0.215,P =0.043).Score of MMSE of NFA group was negatively correlated with tumors diameter(Pearson R=-0.306,P =0.029).(4)The scores of MMSE,CAMCOG-C total,orientation,language,comprehension,expression,memory,remote,recent,recall,attention,praxis,abstract thinking,calculation perception of PA group were statistical lower than the NFA group(P<0.001),excep for calculation P =0.079(>0.05).(5)The cognitive socres of FPA group were statistical lower than the NC group(P<0.001).(6)There were no difference between NFA group and NC gruoup in the cognitive of CAMCOG-C total,language,comprehension,expression,remote,attention,praxis,abstract thinking,calculation,perception of CAMCOG-C as well as MMSE(P >0.05).While NFA group was significant lower than NC group in cognitive score of orirentation,memory,recent and recall(P <0.05).Conclusion:The cognitive functions of pituitary adenoma patients are genearlly impaired,especial in FPA.The endocrine disorders caused by functioning pituita ry adenoma and the compression of the tumor to its surrounding brain tissue might be the main causes of the damage.Objective: To investigate the changes and factors affecting cognitive function before and after surgery in patients with pituitary adenoma(PA),at the same time to carried out the neurospsychological stuatus of patients with PA teated by endoscopic transsphenoidal surgery(TSS)or by microscopic transsphnoidal surgery(TSS).Methods:76 patients were enrolled into our study,who were diagnosed of PA by pathological evidence postoperative,and the follow–up time is three month.The number of FPA was 34 cases,and the NFA was 42 cases.Patients' s characteristic datas were collected preoperative,include age,gender,education,course of disease(starting from occurrence of related symptoms and signs in patients chief complaint,MRI and eyesight(examination from ophthalmology)were performed before and three month later after the operation.Blood sample were collected from patients for hormonal tests before and three month later after operation,including cortisol,growth hormone(GH),prolactin(PRL),adenocorticotroopic hormone(ACTH),cortisol(COR),Thyr-oxine(T3and T4),thyrotropin(TSH),estradiol(E),testosterone(T),follicle stimulating hormone(FSH),and luteinizing hormone(LH).On the same day cognitive evaluation was conducted to obtain the cognitive function scores with CAMCOG-C and MMSE,the same cognitive function tests were performed three month postoperative.All patients were performed through single-nostril transspahenoidal surgrey(TSS),they were divided into microscopic TSS group(31cases)or endoscopic TSS group(45 cases)freedly.After operation the endocrine therapy were performed according to the serum hormone test,and the complications were recroded such as csf leakage,intracranial hemorrhage et al.AS the normal control,one family member or friend of the recruited patiend with matched age,gender,and education background,was also recruited with consent.the data were Analyzed using SPSS 16.0 with the assistance from the Statistics department of Anhui Medical University.Results: Tumors were total resected in 55 cases(72.38%)according to the MRI three months later after the operation.Before operation,the cognitive function scores of PA group is statistical lower than the NC group in MMSE,CAMCOG-C total,orientation,language(P<0.05).The cognitive function scores of PA group in MMSE,CAMCOG-C total,orientation,language,comprehension,remote,recall,praxis,abstract thinking,perception.were statistical lower(P<0.05)than the scores of NC group,except for express,recent,attention and calculation(P >0.05),three month after operation.The cognitive function scores of FPA group in MMSE,CAMCOG-C total,language,express,memory total,remote,recent,recall,attention,praxis,calculation and precption were not inproved(P >0.05)three month postoperation,except for CAMCOG-C,orientation,abstract thinking,comprehension(P<0.05).The cognitive function scores of NFA group in language,comprehension,express,remote,recent,attention,praxis,abstract thinking,calculation and perception were not improved(P >0.05),while the scores in MMSE,CAMCOG-C total,orientation,memory total,recall,were significant improved than before operation.(P <0.05).The hyper-status of COR,PRL,ACTH and GH in serum test were significent lower than preoperation(P <0.05),but only 18 cases(total is 34 cases,52.94%)move to the normal level.The hypo-status of TSH,GH,T3,T4,T in serum test were not significent improved(P >0.05).There were no statistical difference of endoscopic TSS and microscopic TSS in total resection rate of tumor,endocrine disorder improvement and cognitive function scores postoperation.Conclusion: Surgical treatment can improve cognitive function in patients with PA.The tumor resection and the improvement in postoperative endoscrine disorders maybe the main factor of improved cognitive functions.Pituitary adenoma patients with cognitive impairment is not a short-term phenomenon.There is no significant difference has been found in cognitive impairment,total resection rate and changing of the endocrine status between the endoscopic and microscopic TSS.