Abstract
Introduction: It has been proposed that exposure to high levels of endogenous steroids in untreated
pituitary Cushing's disease damages hippocampal structures leading to impairment in
learning and memory processes. We hypothesised that patients with treated pituitary
Cushing's disease would perform significantly worse on tests of cognitive ability
than those with nonfunctioning pituitary adenomas. Design: Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning
pituitary adenomas (NFA) undertook the following comprehensive neuropsychological
assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal
Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making
Test (TMT: executive functioning and attention), Adult Memory and Information Processing
Battery (AMIPB: Information Processing Speed and Story Recall subtests). Results: There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD
mean=102, SD=13), in verbal learning nor any significant difference in the percentage
of verbal material retained in story recall (AMIPB). Performance on higher executive
tasks Stroop and TMT and on measures of information processing was similar. However,
there were significant decrements between some mean scores for both groups and published
normative data with a clear association between higher HADS depression scores and
impaired objective memory and attention which was not specific to PCD. Conclusions: We found no difference in cognitive function between patients with PCD and NFA. The
results suggest a discrepancy between patients’ subjective perception of functional
cognitive impairments and objective findings on psychometric testing and point to
the influence of affective symptoms on cognitive performance, particularly in Cushing's
disease.
Key words
Glucocorticoids - pituitary adenoma - cognition
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Correspondence
DM AdrianHeald
Hope Hospital·Department of Endocrinology and Diabetes
Stott Lane
M6 8HD Salford
United Kingdom
Phone: 00/44/16 12 06 51 46
Fax: 00/44/16 12 06 59 89
Email: aheald@fs1.ho.man.ac.uk