Predictive factors for neurocognitive function and Quality of Life after surgical treatment for Cushing’s disease and acromegaly

• Published in: Journal of endocrinological investigation Vol. 34; no. 7; pp. e168 - e177
• Main Authors: Psaras, T., Milian, M., Hattermann, V., Will, B. E., Tatagiba, M., Honegger, J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2011
• Subjects: Acromegaly - complications; Acromegaly - physiopathology; Acromegaly - surgery; Adult; Aged; Cognition - physiology; Cognition Disorders - etiology; Cognition Disorders - physiopathology; Electronic Contents; Endocrinology; Female; Follow-Up Studies; Humans; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Neuropsychological Tests; Pituitary ACTH Hypersecretion - complications; Pituitary ACTH Hypersecretion - physiopathology; Pituitary ACTH Hypersecretion - surgery; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Acromegaly; neurocognition; quality of life; Cushing’s disease
• ISSN: 0391-4097; 1720-8386
• DOI: 10.3275/7333

Background: Cushing’s disease (CD) and acromegaly (AC) are associated with impairment in quality of life (QoL) and neurocognition that can persist after successful treatment. Aim: To investigate the influence of current disease status (remission vs no remission) on neurocognitive function and QoL in treated CD and AC patients and to determine predictive factors (e.g. demographic, clinical, neurosurgical, endocrinological) for post-operative neurocognition and QoL. Subjects and methods: Twenty-four CD and 37 AC patients underwent neuropsychological testing 1 to 10 yr following surgical therapy. Additionally, QoL was assessed. An overnight 2-mg dexamethasone suppression test in CD and IGF-I and GH levels in AC patients were assessed to determine current disease status. The results were compared with 28 sex-, education- and age-matched healthy controls (HC). Results: Impaired QoL was more pronounced than neurocognitive decrease in both pathologies compared to HC. This finding was independent of the current status of disease. In AC, persistent comorbidities were associated with impaired QoL ( p <0.05). Older age at operation in AC patients was a significant predictor for adverse effects on psychomotor speed and attentional functions ( p <0.05). In CD persistent hypocortisolism, not hypercortisolism, had adverse effects on neurocognition ( p <0.01). Conclusions: The current status of disease plays a subordinate role in postoperative outcome concerning QoL and neurocognition in either pathology. A possible explanation might be the considerably improved endocrinopathy after treatment compared to untreated patients, even if no cure is achieved. The lasting impairments might be explained by irreversible changes that have occurred during the active phase of the disease.