Effects of previous growth hormone excess and current medical treatment for acromegaly on cognition

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Brummelman, Pauline ; Koerts, Janneke ; Dullaart, Robin P. F. ; van den Berg, Gerrit ; Tucha, Oliver ; Wolffenbuttel, Bruce H. R. ; van Beek, Andre P. (2012)

Background In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this study was to compare cognitive functioning of patients who are treated for acromegaly with patients with non-functioning pituitary adenomas (NFA). In addition, we assessed the influence of prolonged medical treatment after initial transsphenoidal surgery on cognition. Design In this cross-sectional study, 74 patients participated, who were treated for acromegaly (n = 50; median [interquartile range] age: 53 [4565] years) or NFA (n = 24; age: 63 [5970] years). The NFA patients were selected for a high likelihood of normal GH secretion based on an IGF-1 z-score within the normal range (> -2) and zero or one axis substituted. Of the acromegaly patients, 28 had achieved remission, while 22 were biochemically controlled with long-acting somatostatin analogues and/or pegvisomant. Memory and executive functioning were assessed by the 15 Words Test and the Ruff Figural Fluency Test, and reported as z-scores. Results The total patient group scored significantly poorer than the reference population on memory and executive functioning (P <0.001). However, cognitive test performance was not significantly different between acromegaly patients with a persistent disease, acromegaly patients in remission and NFA patients. Conclusion The total patient group scored worse compared with reference populations. We found no association between previous GH excess and cognition. In addition, current medical treatment for GH excess in acromegaly was not related to memory and executive functioning.
  • References (30)
    30 references, page 1 of 3

    1 Van Dam PS, Aleman A. Insulin-like growth factor-I, cognition and brain ageing. Eur J Pharmacol 2004;490:87-95.

    2 Sathiavageeswaran M, Burman P, Lawrence D, Harris AG, Falleti MG, Maruff P. Effects of GH on cognitive function in elderly patients with adult-onset GH deficiency: a placebo-controlled 12- month study. Eur J Endocrinol 2007;156:439-47.

    3 Oertel H, Schneider HJ, Stalla K, Holsboer F, Zihl J. The effect of growth hormone substitution on cognitive performance in adult patients with hypopituitarism. Psychoneuroendocrinology 2004;29:839-50.

    4 Faletti MG, Maruff P, Burman P, Harris A. The effects of growth hormone (GH) deficiency and GH replacement on cognitive performance in adults: a meta analysis of the current literature. Psychoneuroendocrinology 2006;31:681-91.

    5 Leon-Carrion J, Martin-Rodriguez JF, Madrazo-Atutxa A, Soto-Moreno A, Venegas-Moreno A, Torres-Vela E et al. Evidence of cognitive and neurophysiological impairment in patients with untreated naive acromegaly. J Clin Endocrinol Metab 2010;95:4367-79.

    6 Van den Berg E, Kloppenburg RP, Kessels RP, Kappelle LJ, Biesels GJ. Type II diabetes mellitus, hypertension, dyslipidemia and obesity: a systematic comparison of their impact on cognition. Biochim Biophys Acta 2009;1792:470-81.

    7 Sievers C, Sa¨mann PG, Pfister H, Dimopoulou C, Czisch M, Roemmler J et al. Cognitive function in acromegaly: description and brain volumetric correlates. Pituitary 2012;15:350-7

    8 Tiemensma J, Biermasz NR, Van der Mast RC, Wassenaar MJE, Middelkoop HAM, Pereira AM et al. Increased psychopathology and maladaptive personality traits, but normal cognitive functioning in patients after long term cure of acromegaly. J Clin Endocrinol Metab 2010;95:E392-402.

    9 Biermasz NR, Pereira AM, Fro¨ lich M, Romijn JA, Veldhuis JD, Roelfsema F. Ocreotide represses secretory-burst mass and nonpulsatile secretion but does not restore event frequency or orderly GH secretion in acromegaly. Am J Physiol Endocrinol Metab 2004;286:E25-30.

    10 Neggers SJ, Kopchick JJ, Jørgensen JO, van der Lely AJ. Hypothesis: extra-hepatic acromegaly: a new paradigm? Eur J Endocrinol 2011;164:11-6.

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