Endocrine Abstracts (2013) 32 P858 | DOI: 10.1530/endoabs.32.P858

The clinical characteristics of pain in patients with pituitary adenomas

Christina Dimopoulou1,2, Anastasia Athanasoulia1, Erik Hanisch1, Stefanie Held1, Thomas Toelle3, Till Sprenger3, Walter Zieglgänsberger1, Hildegard Pfister1, Josephine Roemmler2, Jochen Schopohl2, Guenter Stalla1 & Caroline Sievers1

1Max Planck Institute of Psychiatry, Munich, Germany; 2Medizinische Klinik IV, Ludwig-Maximilians-University, Munich, Germany; 3Department of Neurology, Technische Universität München, Munich, Germany.

Introduction: Clinical presentation of pituitary adenomas frequently involves pain, particularly headache, probably due to both structural and functional properties of the tumour.

Design: In a retrospective analysis, we investigated clinical characteristics of pain in 277 patients with pituitary disease (n=81 acromegaly; n=50 Cushing’s disease; n=86 prolactinoma; n=60 non-functioning pituitary adenoma). Specific pain patterns were measured using three standardized pain questionnaires, MIDAS (Migraine Disability Assessment), the painDETECT and the DGSS (German Society for the Study of Pain) questionnaire.

Results: For the whole group, 156 tumours were macroadenomas (56%) and 121 were microadenomas (44%). Cavernous sinus invasion was observed in 55 tumours (20%). The commonest tumour associated with pain was adrenocorticotropic adenoma (n=17; 34%), followed by growth hormone secreting (n=23; 28%), prolactinoma (n=20; 23%) and non-functioning pituitary adenoma (n=8; 13%). Primary pain site was located in the lower back/bottom region (68.2%) and in the mouth/face/head region (61.9%). Regarding pain quality and severity, the majority of the pituitary patients (89%) described their pain as ‘deep’ in contrast to ‘surface’ pain and reported on a scale of 0 (=no pain) to 10 (=most severe pain) a median pain intensity of 4 (IQR 3.0–6.0) within the last 4 weeks. Pituitary patients presented primarily with an episodic (46%) followed by a permanent/chronic (30%) pain component. Most common pain-associated features comprised noise sensitivity (67.9%), visual disturbances (64%), photophobia (56%) and nausea (53.8%). Both physical (81.4%) and emotional stress (46.5%) were reported to trigger pain. Tumour-associated headache leads to severe levels of disability in daily life in a minority of patients (13.5%).

Conclusion: Pain appears to be a significant problem in pituitary disease and is associated with a range of pain phenotypes. A combination of factors including tumour activity, cavernous sinus invasion, as well as previous predisposition to pain might play a role in pain phenotypes.