Download PDF
Exp Clin Endocrinol Diabetes 2016; 124(03): 187-191
DOI: 10.1055/s-0035-1569340
Article
© Georg Thieme Verlag KG Stuttgart · New York

Health-related Quality of Life in Patients After Treatment of Cushing’s Disease

S. Nader
1   Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
T. Burkhardt
1   Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
E. Vettorazzi
2   Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
M. Milian
3   Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
,
J. Aberle
4   Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
S. Petersenn
5   ENDOC Center for Endocrine Tumors, Hamburg, Germany
,
J. Flitsch
1   Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

received 05 October 2015
first decision 05 October 2015

accepted 07 December 2015

Publication Date:
23 March 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Background: Patients suffering from Cushing’s disease are known to be restricted due to a wide range of symptoms. Despite biochemical cure, symptoms might last life-long. These include – among well-known somatic symptoms – several neuropsychiatric symptoms that cannot be as easily tested, but lead to a serious negative impact on quality of life. We aimed to evaluate what factors diminish the self-perceived quality of life the most using 3 questionnaires visualizing those impairments. Furthermore we investigated whether there would be differences in quality of life between patients still being affected by the disease and those that are already in remission.

Patients and Methods: We reviewed patient charts treated between April 2008 and June 2012 for Cushing’s disease and sent 3 questionnaires to the patients for evaluation. For this purpose we used the SF-36, the BDI and the Tuebingen CD-25. 54 patients complied with our request and returned the completed questionnaires. The average time after surgery was 36 months.

Results: In all 8 dimensions of the SF-36 significant differences between the patient collective and the expected age- and gender-specific scores could be observed and thus a detectable impairment in quality of life. The BDI revealed that every other patient suffering from Cushing’s disease presented depressive symptoms, partially with clinical relevance. In all 6 dimensions of the Tuebingen CD-25 there were notable restrictions in patients. Those restrictions particularly concerned bodily restrictions and cognitive performance. The self-perceived quality of life of active patients was – although not statistically significant – in almost all measured fields worse than the test results of patients in remission after TSS.

Conclusion: Former and active Cushing’s disease patients suffer from a wide range of neuropsychiatric symptoms. Those symptoms might dominate the clinical picture and lead to a serious impairment in quality of life as well as extend periods of suffering and might persist even years after being found healthy. Therefore it is important to evaluate quality of life as an independent factor in every patient being affected by Cushing’s disease and to include a holistic view in their therapy. Concomitant therapeutic measures should be accessible at any time for Cushing’s disease patients as the normalization of pathologically increased laboratory values doesn’t obligatory lead to an improvement of the patients subjectively felt well-being.

Key words

cushing’s disease - depression - quality of life - remission
 

  • References

  • 1 Pigou AC. The economics of welfare. 1920. 1st (ed.).
    Google Scholar
  • 2 Najman JM, Levine S. Evaluating the impact of medical care and technologies on the quality of life: a review and critique. Soc Sci Med F 1981; 15: 107-115
    PubMedGoogle Scholar
  • 3 Bullinger M. German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 1995; 41: 1359-1366
    CrossrefPubMedGoogle Scholar
  • 4 Heald AH, Gosh S, Bray S et al. Long-term negative impact on quality of life in patients with successfully treated Cushing’s disease. Clin Endocrinol (Oxf) 2004; 61: 458-465
    CrossrefPubMedGoogle Scholar
  • 5 Tiemensma J, Kokshoorn NE, Biermasz NR et al. Subtle cognitive impairments in patients with long-term cure of Cushing’s disease. J Clin Endocrinol Metab 2010; 95: 2699-2714
    CrossrefPubMedGoogle Scholar
  • 6 Dorn LD, Burgess ES, Dubbert B et al. Psychopathology in patients with endogenous Cushing’s syndrome: ‘atypical’ or melancholic features. Clin Endocrinol (Oxf) 1995; 43: 433-442
    CrossrefPubMedGoogle Scholar
  • 7 Flitsch J, Spitzner S, Ludecke DK. Emotional disorders in patients with different types of pituitary adenomas and factors affecting the diagnostic process. Exp Clin Endocrinol Diabetes 2000; 108: 480-485
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Dorn LD, Burgess ES, Friedman TC et al. The longitudinal course of psychopathology in Cushing’s syndrome after correction of hypercortisolism. J Clin Endocrinol Metab 1997; 82: 912-919
    CrossrefPubMedGoogle Scholar
  • 9 Loosen PT, Chambliss B, DeBold CR et al. Psychiatric phenomenology in Cushing’s disease. Pharmacopsychiatry 1992; 25: 192-198
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Ferrando AA, Stuart CA, SHeffield-Moore M et al. Inactivity amplifies the catabolic response of skeletal muscle to cortisol. J Clin Endocrinol Metab 1999; 84: 3515-3521
    PubMedGoogle Scholar
  • 11 Forget H, Lacroix A, Somma M et al. Cognitive decline in patients with Cushing’s syndrome. J Int Neuropsychol Soc 2000; 6: 20-29
    PubMedGoogle Scholar
  • 12 Kelly WF. Psychiatric aspects of Cushing’s syndrome. QJM 1996; 89: 543-551
    CrossrefPubMedGoogle Scholar
  • 13 van Aken MO, Pereira AM, Biermasz NR et al. Quality of life in patients after long-term biochemical cure of Cushing’s disease. J Clin Endocrinol Metab 2005; 90: 3279-3286
    CrossrefPubMedGoogle Scholar
  • 14 Kelly WF, Kelly MJ, Faragher B. A prospective study of psychiatric and psychological aspects of Cushing’s syndrome. Clin Endocrinol (Oxf) 1996; 45: 715-720
    CrossrefPubMedGoogle Scholar
  • 15 Webb SM, Badia X, Barahona MJ et al. Evaluation of health-related quality of life in patients with Cushing’s syndrome with a new questionnaire. Eur J Endocrinol 2008; 158: 623-630
    CrossrefPubMedGoogle Scholar
  • 16 Bullinger MKI. SF-36 Fragebogen zum Gesundheutszustand. Göttingen Vol. 1 1998; 155
    PubMedGoogle Scholar
  • 17 Beck AT. A systematic investigation of depression. Compr Psychiatry 1961; 2: 163-170
    CrossrefPubMedGoogle Scholar
  • 18 Beck AT, Beamesderfer A. Assessment of depression: the depression inventory. Mod Probl Pharmacopsychiatry 1974; 7: 151-169
    PubMedGoogle Scholar
  • 19 Milian M, Teufel P, Honegger J et al. The development of the Tuebingen Cushing’s disease quality of life inventory (Tuebingen CD-25). Part I: construction and psychometric properties. Clin Endocrinol (Oxf) 2012; 76: 851-860
    CrossrefPubMedGoogle Scholar
  • 20 Milian M, Teufel P, Honegger J et al. The development of the Tuebingen Cushing’s disease quality of life inventory (Tuebingen CD-25). Part II: normative data from 1784 healthy people. Clin Endocrinol (Oxf) 2012; 76: 861-867
    CrossrefPubMedGoogle Scholar
  • 21 Badia X, Valassi E, Roset M et al. Disease-specific quality of life evaluation and its determinants in Cushing’s syndrome: what have we learnt?. Pituitary 2013
    PubMedGoogle Scholar
  • 22 Milian M, Honegger J, Teufel P et al. Tuebingen CD-25 is a sensitive tool to investigate health-related quality of life in Cushing’s disease patients in the course of the disease. Neuroendocrinology 2013; 98: 188-199
    CrossrefPubMedGoogle Scholar
  • 23 Santos A, Resmini E, Martinez MA et al. Quality of life in patients with pituitary tumors. Curr Opin Endocrinol Diabetes Obes 2009; 16: 299-303
    CrossrefPubMedGoogle Scholar
  • 24 Wagenmakers MA, Netea-Maier RT, Prins JB et al. Impaired quality of life in patients in long-term remission of Cushing’s syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?. Eur J Endocrinol 2012; 167: 687-695
    CrossrefPubMedGoogle Scholar
  • 25 Mura G, Cossu G, Migliaccio GM et al. Quality of life, cortisol blood levels and exercise in older adults: results of a randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10: 67-72
    CrossrefPubMedGoogle Scholar
  • 26 Carluccio A, Sundaram NK, Chablani S et al. Predictors of quality of life in 102 patients with treated Cushing’s disease. Clin Endocrinol (Oxf) 2015; 82: 404-411
    CrossrefPubMedGoogle Scholar
  • 27 Plotz CM, Knowlton AI, Ragan C. The natural history of Cushing’s syndrome. Am J Med 1952; 13: 597-614
    CrossrefPubMedGoogle Scholar