Neurocognitive function in acromegaly after surgical resection of GH-secreting adenoma versus naïve acromegaly.
Neurocognitive function in acromegaly after surgical resection of GH-secreting adenoma versus naïve acromegaly.
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DOI：
10.1371/journal.pone.0060041
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Leal-Cerro A
中科院分区：
文献类型：
--
作者：
Martín-Rodríguez JF;Madrazo-Atutxa A;Venegas-Moreno E;Benito-López P;Gálvez MÁ;Cano DA;Tinahones FJ;Torres-Vela E;Soto-Moreno A;Leal-Cerro A
未经治疗的活动期肢端肥大症患者表现出轻到中度的神经认知障碍，这些障碍与长期接触生长激素(GH)和胰岛素样生长因子(IGF-I)高分泌有关。然而，目前尚不清楚在控制GH/IGF-I高分泌后，这些疾病是否会得到改善。这项研究的目的是比较成功接受生长激素腺瘤经蝶窦手术的患者(治愈患者)和幼稚的肢端肥大症患者的神经认知功能。此外，我们希望确定不同的临床和生化变量对活动期疾病患者和长期治愈后患者神经认知状态的影响。一组六项标准化的神经心理测试评估了注意力、记忆力和执行功能。此外，使用低分辨率电磁层析成像(LORETA)溶液进行定量脑电检查，以获得有关患者神经生理状态的信息。神经认知数据与健康对照组进行比较。使用临床和激素参数进行多元线性回归分析，以获得一组治疗前和治疗后神经认知状态的独立预测因素。这两组患者在记忆测试中的得分都明显低于健康对照组，特别是在评估视觉和语言回忆的测试中。治愈的肢端肥大症患者并不比天真的患者获得更好的认知测试。此外，在两组患者中，记忆缺陷都与左侧内侧颞叶皮质的β活性降低有关。回归分析显示，未经治疗的肢端肥大症持续时间较长与更严重的神经认知并发症有关，而无论诊断组如何，而评估时的GH水平仅与幼稚患者的神经认知结果有关。肢端肥大症术后生化缓解时间越长，神经认知状态越好。总体而言，这一数据表明，长期暴露于GH/IGF-I过度分泌的影响可能会对大脑功能产生长期影响。
Patients with active untreated acromegaly show mild to moderate neurocognitive disorders that are associated to chronic exposure to growth hormone (GH) and insulin-like growth factor (IGF-I) hypersecretion. However, it is unknown whether these disorders improve after controlling GH/IGF-I hypersecretion. The aim of this study was to compare neurocognitive functions of patients who successfully underwent GH-secreting adenoma transsphenoidal surgery (cured patients) with patients with naive acromegaly. In addition, we wanted to determine the impact of different clinical and biochemical variables on neurocognitive status in patients with active disease and after long-term cure. A battery of six standardized neuropsychological tests assessed attention, memory and executive functioning. In addition, a quantitative electroencephalography with Low-Resolution Electromagnetic Tomography (LORETA) solution was performed to obtain information about the neurophysiological state of the patients. Neurocognitive data was compared to that of a healthy control group. Multiple linear regression analysis was also conducted using clinical and hormonal parameters to obtain a set of independent predictors of neurocognitive state before and after cure. Both groups of patients scored significantly poorer than the healthy controls on memory tests, especially those assessing visual and verbal recall. Patients with cured acromegaly did not obtain better cognitive measures than naïve patients. Furthermore memory deficits were associated with decreased beta activity in left medial temporal cortex in both groups of patients. Regression analysis showed longer duration of untreated acromegaly was associated with more severe neurocognitive complications, regardless of the diagnostic group, whereas GH levels at the time of assessment was related to neurocognitive outcome only in naïve patients. Longer duration of post-operative biochemical remission of acromegaly was associated with better neurocognitive state. Overall, this data suggests that the effects of chronic exposure to GH/IGF-I hypersecretion could have long-term effects on brain functions.
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