Endocrine Abstracts

Neurocognitive dysfunction has been described in patients following pituitary radiotherapy. However, the relative contributions of other variables such as hormone-deficiency states and surgery is still unknown. Our aim was to compare the results of an examination of executive function in acromegalic patients treated with transsphenoidal surgery (TS) alone to those obtained from patients treated with TS followed by conventional radiotherapy (CR) using a two-field technique. We retrospectively compared these two outcome groups and carried out a Wisconsin Card Sorting Test (WCST). Sixty-six patients, 26 men and 40 women, aged 55.2±12.4 years, with an average duration of symptoms before diagnosis of 5.1±3.7 years, were included in this study. Forty-two patients were treated only by TS and 24 received additional CR. There were no significant differences between groups in sex, age, average duration of symptoms before diagnosis, and mean GH and IGF-1 levels before TS (18.1 and 21.1 μg/l for GH, and 820.1 and 889 μg/l for IGF-1, respectively in both radiated and not radiated groups). Although there were more pituitary deficits in the radiated group when their executive functioning was assessed, the prevalence of growth hormone deficiency was similar in both groups, as well as the percentage of patients that achieved criteria for cure. The CR group performed significantly worse than the TS group, with mean centiles based on age-adjusted normative data of 10.5 vs 27.9 for perseverative answers (P=0.007) and 11.7 vs 28.5, for perseverative errors in each group (P=0.012). The CR group committed also more total errors and required more trials to achieve the first category but these differences were not statistically significant. In our study, postoperative CR in patients with acromegaly is associated with a poorer performance on the WCST when compared to TS alone, documenting specific problems in conceptual flexibility.