Neurocognitive consequences of surgery and radiotherapy for tumours of the pituitary.

The management of patients with pituitary tumours requires a multidisciplinary approach utilizing a number of different treatment modalities that can impact upon pituitary function and may disrupt important areas of cerebral tissue that are important for normal neurocognitive function. Patients frequently report problems with memory and sustained attention that impact upon normal day-to-day life. At present it is unclear whether any causal link exists between treatments for pituitary tumours and abnormalities of memory and higher mental function. The domains of function affected in patients with pituitary tumours are memory and executive functions, which are involved in the control and direction of lower level, more automatic functions such as attention and motor skills. The evidence for disruption in these modalities is stronger for memory than for executive function. This may be due to variability in study design, insufficient tests and the potential inclusion of fundamentally different tumour types. The purpose of this review is to examine the available evidence to determine whether pituitary disease, its management, or subsequent complications are responsible for any neuropsychological deficits in pituitary patients. Furthermore we address methodological issues that may account for the apparent disparate neurocognitive data that exist in this patient group.