Victoria van Trigt¹, Cornelie Andela², Leontine Bakker³, Iris Pelsma⁴, Nienke Biermasz⁵


(1) Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Netherlands, Netherlands. (2) Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Netherlands, Netherlands. (3) Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Netherlands, Netherlands. (4) Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Netherlands, Netherlands. (5) Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Netherlands, Netherlands.

Purpose:

To assess cognitive functioning and psychological complaints in patients with treated prolactinoma. 

Methods:

A cross-sectional study comparing patients treated for prolactinoma to healthy controls matched for age, gender, and education. The cognitive assessment included eight tests assessing memory, verbal fluency, processing speed, selective attention, and executive functioning. Additionally, patients completed seven validated questionnaires on psychological complaints. Mean±SD results presented as β with 95% confidence intervals.

Results:

Sixty patients (controlled on dopamine agonists, n=30; in surgical remission, n=30), among whom 41 (68.3%) female, aged 42.3±11.7 years old, were compared to 60 matched healthy controls. Mild cognitive impairments were seen in verbal memory (fewer words on Verbal Learning Test of Rey, e.g., delayed delivery: β=-1.8, (-2.7–1.0), p=0.038), selective attention (fewer correct digits on Digit Deletion Test: β=-8.8 (-16.2–0.2), p=0.019), longer time on Trail Making Test part A: β=5.2 (-3.2-7.2), p<0.001), and processing speed (fewer correct substitutions on Digit-Symbol Substitution test: β=4.2 (-8.2–0.2), p=0.040). Furthermore, patients reported higher degrees of apathy (Apathy Scale: β=2.4 ( 0.6-4.1), p=0.009), irritability (Irritability Scale: β=2.2 (0.3-4.1), p=0.024), fatigue (Fatigue Severity Scale: β=6.7, (2.7-10.8), p<0.001), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale, anxiety: β=1.1 (0.1-2.1), p=0.034; depression: β=1.7 (0.8-2.7), p<0.001) and exhibited higher levels of negativism (β=2.8 (0.8-4.9), p=0.007), somatization (β=7.3 (5.0-9.5), p<0.001), severe psychopathology (β=1.9 (0.8-3.1), p=0.001), and less extraversion (β=-3.7 (-6.7–0.7), p=0.0015).

Conclusion:

Compared to healthy matched controls, patients treated for prolactinoma showed subtle cognitive impairments (i.e., memory, attention, and processing speed) and reported more psychological complaints. Physicians should be aware of these impairments to adequately address them.