title: Cognition and brain abnormalities on MRI in pituitary patients.
abstract: OBJECTIVE
  The extent to which cognitive dysfunction is related to specific brain abnormalities in patients treated for pituitary macroadenoma is unclear. Therefore, we compared brain abnormalities seen on Magnetic Resonance Imaging (MRI) in patients treated for nonfunctioning pituitary macroadenoma (NFA) with or without impairments in cognitive functioning.
  
  
  METHODS
  In this cross-sectional design, a cohort of 43 NFA patients was studied at the University Medical Center Groningen. White matter lesions (WMLs), cerebral atrophy, (silent) brain infarcts and abnormalities of the temporal lobes and hippocampi were assessed on pre-treatment and post-treatment MRI scans. Post-treatment cognitive examinations were performed using a verbal memory and executive functioning test. We compared our patient cohort with large reference populations representative of the Dutch population.
  
  
  RESULTS
  One or more impairments on both cognitive tests were frequently observed in treated NFA patients. No treatment effects were found with regard to the comparison between patients with and without impairments in executive functioning. Interestingly, in patients with one or more impairments on verbal memory function, treatment with radiotherapy had been given more frequently (74% in the impaired group versus 40% in the unimpaired group, P=0.025). Patients with or without any brain abnormality on MRI did not differ in verbal memory or executive functioning.
  
  
  CONCLUSIONS
  Brain abnormalities on MRI are not observed more frequently in treated NFA patients with impairments compared to NFA patients without impairments in verbal memory or executive functioning. Conversely, the absence of brain abnormalities on MRI does not exclude impairments in cognition.
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Brummelman
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Margriet G A
authors.initials: MG
authors.lastname: Sattler
authors.affiliation: Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Meiners
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Gerrit
authors.initials: G
authors.lastname: van den Berg
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: van der Klauw
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands; LifeLines Cohort Study & Biobank, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Martin F
authors.initials: MF
authors.lastname: Elderson
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Robin P F
authors.initials: RP
authors.lastname: Dullaart
authors.affiliation: Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Koerts
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: j.werumeus.buning@umcg.nl.
authors.forename: Jorien
authors.initials: J
authors.lastname: Werumeus Buning
authors.affiliation: Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Oliver
authors.initials: O
authors.lastname: Tucha
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands; LifeLines Cohort Study & Biobank, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Bruce H R
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Alfons C M
authors.initials: AC
authors.lastname: van den Bergh
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: a.p.van.beek@umcg.nl.
authors.forename: André P
authors.initials: AP
authors.lastname: van Beek
mesh_terms: D000236:Adenoma / Q000628:therapy*; D000368:Aged; D001284:Atrophy / Q000175:diagnosis; D001921:Brain / Q000473:pathology*; D020520:Brain Infarction / Q000175:diagnosis; D003071:Cognition; D003072:Cognition Disorders / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology* / Q000628:therapy*; D013702:Temporal Lobe / Q000473:pathology
keywords: Brain side effects; Cognitive performance; MR imaging; Pituitary adenomas; Postoperative radiotherapy