Why do patients with pituitary adenomas have headache?

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 130-162-Neuroendocrinology
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-142
IIonka Kreitschmann-Andermahr*1, Renata Weber Carneiro1, Sonja Siegel1, Rolf Buslei1, Michael Buchfelder1 and Georg Brabant2
1University Hospital Erlangen, Erlangen, Germany, 2Experimental and Clinical Endocrinology, Luebeck, Germany
Objective: Headache is a very common feature in pituitary disease and is reported to be present in more than one third of all patients with pituitary adenomas. Tumor size or cavernous sinus invasion, traction or displacement of intracranial pain-sensitive structures such as blood vessels, cranial nerves and dura mater are implicated causes. Psychosocial characteristics play an important role in the pathogenesis of patients with primary headache but have so far not been investigated in patients who have headache and pituitary disease. In this study, it was our aim to differentiate clinical, imaging, psychosocial and personality characteristics of patients with and without headache admitted for surgery of pituitary adenomas in our department.

 Methods: A series of 22 consecutive patients (9 male, 13 female, mean age 53.9 years) with pituitary adenomas was investigated. All patients filled in self-rating questionnaires pertaining to headache, depression, quality of life and personality structure before surgery (21 transsphenoidal surgeries, 1 transcranial operation). Tumor size on MRI (8 micro- versus 14 macroadenomas), hormonal oversecretion (13 patients with hormonal oversecretion, 9 without) presence of sinus cavernous invasion and histopathological findings were also analysed.

 Results: Seven of the 22 patients reported headache. Tumor size, cavernous sinus invasion, hormonal oversecretion or gender were not related to headache (Fisher’s exact test n.s..) Patients with headache obtained, however, significantly higher conscientiousness (M-W-U p=0.006) and agreeableness scores (M-W-U p=0.048) on the self-rating personality form NEO-FFI while they did not differ from patients without headache with respect to neuroticism and depression (M-W-U n.s.)

 Conclusion: In contrast to the literature, in our small series, tumor size, hormonal oversecretion or invasiveness were not associated with headache in pituitary adenoma patients. Our results rather stress the importance of personality factors in the development of tumor related headache. The observed relationship between conscientiousness, agreeableness and headache in pituitary diseases is in line with recent findings of high conscientiousness scores as a significant contributor to the pathogenesis of primary headache, i.e. migraine. Psychosocial factors probably play a yet underestimated role in headaches associated with pituitary diseases.

Nothing to Disclose: IK, RW, SS, RB, MB, GB

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This study was supported in part by an independent investigator grant from Pfizer Pharma GmbH, Germany.