Artikel
What are the causes of headache in patients with pituitary adenomas?
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Autoren
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Renata Weber Carneiro
- Department of Neurosurgery, University Hospital Erlangen
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Sonja Siegel
- Department of Neurosurgery, University Hospital Erlangen
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Ralf Buslei
- Institute of Neuropathology, University Hospital Erlangen
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Georg Brabant
- Department of Clinical and Experimental Endocrinology, University of Lübeck
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Michael Buchfelder
- Department of Neurosurgery, University Hospital Erlangen
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Ionka Kreitschmann-Andermahr
- Department of Neurosurgery, University Hospital Erlangen
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: Headache is present in approximately one third of patients with pituitary adenomas. It is supposedly related to tumor size or cavernous sinus invasion and probably caused by traction or displacement of intracranial pain-sensitive structures such as blood vessels, cranial nerves and dura mater. Psychosocial characteristics play an important role in the pathogenesis of patients with primary headache but haven’t been investigated in patients with pituitary disease. 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.
Method: A series of 22 consecutive patients (9 male, 13 female, mean age 53.9 years) with pituitary adenomas was investigated. All patients filled in a compilation of self-rating questionnaires pertaining to headache, depression, quality of life and personality structure before surgery. Transsphenoidal surgery was performed in 21cases while 1 patient underwent a transcranial operation. Tumor size on MRI (8 micro- versus 14 macroadenomas), clinical hormone expression (13 patients with hormonal over secretion, 9 without) presence of sinus cavernous invasion and histopathological findings were also analysed
Results: Seven of the 22 patients presented with headache. Tumor size, hormonal over secretion, cavernous sinus invasion or gender was not related to headache (Fisher's exact test n.s.) However, patients with headache obtained significantly higher conscientiousness (M-W-U p=0.006) and agreeableness scores (M-W-U p=0.048) while they did not differ from patients without headache with respect to neuroticism and depression (M-W-U n.s.)
Conclusions: In contrast to the literature, in our series, tumor size, hormonal over secretion or invasiveness was not associated with headache. Our results rather stress the importance of personality factors in the development of tumor related headache. The observed relation 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. We therefore conclude that personality traits play a yet underestimated role in headaches associated with pituitary diseases.
