H - 67 Socially Responsible Neuropsychology (SRN) in Action: Considering Culture, Brain Structure, and Function Longitudinally in an Atypical Pituitary Adenoma Case.

Abstract

Research on the neuropsychological profile associated with pituitary adenoma (PA) in diverse populations is limited. Clinically, PAs are categorized by size (micro-vs-macro) and hormone secretion levels (functional/secreting-vs-nonfunctional/non-secreting [NFPA]). Macro-NFPA are associated with visual-spatial, memory, and executive functioning declines, likely due to mass effects. No previous reports of cognitive declines in micro-NFPA were found in the literature. We present a clinical case illustrating the application of an SRN model in a 75-year-old, Spanish-English bilingual male, with cognitive declines, diagnosed with micro-NFPA. An SRN model was applied to promote equitable care through evidence-based consideration of neuropsychological syndromes in bilinguals, neurodiagnostics, and complex psychosocial factors. The patient underwent longitudinal language-congruent neuropsychological assessment and structural/functional neuroimaging. Educational background, linguistic proficiencies, acculturation level, social/behavioral comportment, and limitations in available neuropsychological tools/norms were integrated to reflect the complexity in conducting a reliable bilingual assessment and formulating differential diagnoses. The SRN model guided complex clinical decision-making. Neuropsychological profile (frontal-subcortical-vs-cortical-involvement) varied across language and time-point. Within/between variable performances in memory, executive functioning, processing speed, and verbal fluency were inconsistent with structural neuroimaging at assessment points, increasing diagnostic ambiguity. Advocated-for functional neuroimaging revealed pituitary hypometabolism. To our knowledge, this is the first reported case of neurocognitive impairment in micro-NFPA, and the first reported neuropsychological profile of a bilingual individual with PA. The findings suggest the need for further research on neurocognitive declines in NFPA in diverse populations. It also highlights the importance of assessing in all relevant languages when conducting longitudinal assessments to boost sensitivity and specificity in differential diagnoses.