Correlation of Patient Perception of Fatigue, Sleep Disturbance with Motivation and Pituitary Hormonal Deficiencies in Patients with Pituitary Tumors

Friday, 26 July 2013: 10:55 AM

Christine G. Yedinak, DNP, FNP, MN, BS
Department of Neurosurgey, Oregon Health Sciences University Hospital, Portland, OR

Learning Objective 1: 1. Evaluate sleep disturbance, fatigue and motivational disturbance in patients with pituitary tumors.

Learning Objective 2: 2.Describe the relationship between factors associated with sleep disturbance, fatigue and motivational disturbance in patients with pituitary tumors.

Background: Pituitary tumors may be present in 15-30% of the population and are classified by size ( <1cm or >1cm) and hormonal secretory activity (deficiency or excess).  Sleep disturbance has been demonstrated in patients with large tumors but there is a paucity of information regarding sleep disturbance for small tumors.   Such tumors have been presumed to be asymptomatic and treatment has been limited to replacement of pituitary hormonal deficiencies or hypersecretion.  Clinically, patients report sleep disturbance, fatigue and motivational deficits. There are no data that correlate these symptoms and no longitudinal data that reflect the impact of biochemical replacement therapies on these dysfunctions. 

Purpose:   To determine patient perception and severity of sleep disturbance and fatigue and if these correlate to perceived motivational disturbance, tumor size and pituitary hormonal dysfunction in patients with pituitary tumors.

Methods: A total of sixty seven subjects ( 47F/20M) with pituitary tumors meeting criteria were asked to complete a 17 item questionnaire identifying and quantifying sleep disturbance, fatigue and motivational deficiencies on a 6 point Likert scale (no dysfunction to severe dysfunction). On average a moderate level of dysfunction was reported in each category.  

Results: All dysfunctions were significantly correlated (p>.000). There was no significant gender difference in the perception of sleep and motivation dysfunction but females perceived more fatigue than males t(64) = 2.49 ( p=0.015).  A significant correlation was found between sleep disturbance and multiple pituitary hormonal deficiencies (rs=.27, p= 0.027) and greater sleep disturbance correlated with patients with smaller tumors rs=.256, p=0.037.

Conclusion: Patients with small pituitary tumors (<1cm), without pituitary deficiencies, require evaluation and treatment for sleep disturbance with a particular focus on fatigue in women. Further understanding of the etiology of these dysfunctions is needed in order to develop appropriate therapies.