PhD ceremony Ms. P. Brummelman: Cognition in patients treated for pituitary diseases

PhD ceremony: Ms. P. Brummelman

Dissertation: Cognition in patients treated for pituitary diseases

Promotor(s): prof. B.H.R. Wolffenbuttel, prof. O.M. Tucha

Faculty: Medical Sciences

Pituitary diseases are characterized by abnormalities related to undersecretion or oversecretion of pituitary hormones with or without local mass effects. The cause of these diseases is often a pituitary tumour, which is usually benign and emanates from the anterior pituitary. In general, treatment of pituitary adenomas consists of surgery, which may be followed by radiotherapy in cases of a significant tumour remnant or regrowth. Due to the pituitary disease itself, or after treatment with surgery and/or radiotherapy, hormonal therapy may be necessary in case of new or persistent hormonal disturbances. Literature suggests that these different treatment options may have an effect on cognition. However, reported results were inconsistent and mostly derived from small and heterogeneous patient groups according to diagnose and treatment. Therefore, we studied the effects of radiotherapy and hormonal and medical therapy on cognition in large and homogenous groups of patients treated for pituitary diseases. We found that multiple field radiotherapy techniques and fractionated radiation dose regimens did not have a major effect on memory and executive functioning in patients treated for a non-functioning pituitary macroadenoma. In patients treated for acromegaly, we found that previous growth hormone excess and growth hormone suppressive medication were not associated with impaired cognitive functioning. Further, in a large study with extensive neuropsychological evaluation, we found that patients treated for secondary adrenal insufficiency had selective impairments in the cognitive domains of memory, attention, executive functions and social cognition.