Neurocognitive Outcomes in Patients with Pituitary Adenomas

To perform a systematic review to explore the impact of surgical interventions for pituitary adenomas on cognitive function. We assessed diverse cognitive domains, including memory and learning and complex attention and executive function.

We conducted a systematic literature search across six databases. We identified studies published during a 20-year period (2004-2024) that included adult patients diagnosed with NFPA (Non functioning Pituitary adenoma), acromegaly or Cushing's Disease (CD) who had undergone standardised neurocognitive tests pre- and post-surgical interventions. Data synthesis included descriptive statistics and bias assessments using the 'NHLBI' (National Heart, Lung and Blood Institute) and 'GRADE' (Grading of Recommendations Assessment, Development and Evaluation) tools.

We included six eligible studies in our review. Post-operatively, there were significant improvements in memory in patients with diagnosed NFPAs and CD. There was promising recovery of attention, processing speed and working memory following surgical management, particularly for those patients with diagnosed NFPAs. Those patients with diagnosed CD demonstrated post-operative recovery of verbal fluency and general cognition. Conversely, those patients diagnosed with acromegaly had limited improvements in their cognition post-operatively, likely reflecting irreversible neurological changes caused by prolonged exposure to excessive serum levels of growth hormone.

Surgical interventions for pituitary adenomas offer promising cognitive recovery for those patients diagnosed with NFPAs and CD, although cognitive deficits may persist post-operatively, particularly for those diagnosed with acromegaly. The variability in post-operative cognitive outcomes identified in this review highlights a need for standardised cognitive assessments and longitudinal studies to examine cognitive recovery following surgical management of pituitary adenomas. Clinically, routine cognitive assessment and integration of these measures into multidisciplinary management approaches are important to optimise patient outcomes.