An account of the quality of life of patients after treatment for non‐functioning pituitary tumours

Objective: To provide rheumatological assessment of patients with long-standing acromegaly and investigate the impact of musculoskeletal disease on quality of life. Design: Cross-sectional observational study. Methods: Fifty-eight patients diagnosed with acromegaly at least 5 years previously were interviewed and examined by a rheumatologist. Each patient completed the short form-36 (SF-36), arthritis impact measurement scales 2 (AIMS2) and acromegaly quality of life questionnaires (AcroQol). Results: Fifty-two out of 58 (90%) reported musculoskeletal pain, with 29 (50%) reporting neck pain. Hip osteoarthritis was present in 49 (84%) and knee osteoarthritis in 20 (34%). Half the patients (52%) reported sleep disturbance, but only 2 (3.5%) had fibromyalgia. Ten (17.2%) had previously undergone carpal tunnel decompression. Fifty-one (88%) patients had consulted their general practioner and 31 (54%) complementary therapists. SF-36, AIMS2 and AcroQol scores were lower in patients with musculoskeletal pain. Conclusions: This study of musculoskeletal problems in patients with acromegaly reports systematic rheumatological examination, use of medical services and quality of life scores. Musculoskeletal problems should be routinely addressed in acromegaly by both endocrinologist and rheumatologist and a multidisciplinary approach taken to management.European Journal of Endocrinology 158 587-593

Section: Results Of Examinationsupporting

confidence: 60%

“…Scores were compared with normative data for a UK population (18) and with those of 48 patients with nonfunctioning pituitary tumours of mean age 59 (S.D. 12) years from the Oxfordshire region (19).…”

Section: Quality Of Life Assessmentsmentioning

confidence: 99%

Impact of musculoskeletal disease on quality of life in long-standing acromegaly

Miller¹,

Doll²,

David³

et al. 2008

“…Although most reports on QoL using generic questionnaires in NFPA describe a low QoL after treatment (7,11,41,75,76), there are also descriptions of normalization of QoL, after successful treatment, attaining scores comparable to those seen in a healthy population (77,78). As already mentioned, compared to that of other pituitary adenoma patients, QoL of NFPA patients was similar to that of patients treated for prolactinoma, and better than that of patients diagnosed with CD and acromegaly (11,39,79,80).…”

Section: Non-functioning Pituitary Adenomasmentioning

confidence: 71%

“…Prior radiotherapy reportedly is followed by impaired mental health and less energy levels, without affecting the general health perception (77,78). Abnormal scores in energy, physical ability and anxiety have also been R23 Review S M Webb and others Quality of life in pituitary disease www.eje-online.org described in patients with NFPA who experience a tumour recurrence (77,81).…”

Section: Non-functioning Pituitary Adenomasmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Webb

Crespo

Santos

et al. 2017

Background: In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. Objective: To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. Design: Critical review of the pertinent literature and pragmatic discussion of available information. Methods: Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis. Results: QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing's disease (similar to other causes of Cushing's syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine 'cure', scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated. Conclusions: To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.

“…Examples include Bulow et al (8) who found a higher prevalence of mental disorders and distress in hypopituitary women (relative risk of mental disorders 4.5, 95% confidence interval 1-21), with reduced social attachment and integration and an increased prevalence of obsessive-compulsive, phobic and psychotic symptoms. (27) used patients who had previous mastoid surgery as their control group. Overall, there was no significant difference in QOL, but those pituitary patients treated with radiotherapy had impaired mental health, more depression and decreased control of their emotions (assessed using the Short Form-36 and Psychological General Well-Being (PGWB) questionnaires).…”

Section: Discussionmentioning

confidence: 99%

Atypical depression in growth hormone deficient adults, and the beneficial effects of growth hormone treatment on depression and quality of life

Mahajan

Crown²,

Checkley³

et al. 2004

Objective: Some growth hormone deficient adults (GHDAs) have an impaired quality of life, which may improve with growth hormone (GH) treatment. The objective of our study was to make an in-depth psychiatric evaluation of patients with adult-onset (AO) and childhood-onset (CO) GH deficiency (GHD), and to assess the time course of changes in their quality of life and symptoms of depression in response to GH treatment. Design: The study design was a 4-month, double-blind, cross-over, placebo-controlled trial of GH therapy. Methods: We used a detailed psychiatric interview to characterise 25 patients with proven GHD at baseline. They were reassessed at monthly intervals during treatment with GH or placebo, using the Nottingham Health Profile and two well-recognised depression rating scales. Results: 11/18 (61%) of the patients with AO-GHD, but 0/7 of the patients with CO-GHD, were found to have atypical depression at baseline. There were significant improvements in the depression rating scale scores after 2 months of GH therapy, with significant improvements in emotional reaction and social isolation scores from 1 month, and in energy levels and sleep disturbance from 2 and 3 months respectively. Conclusions:The results of our study confirm that a large proportion of GHDAs have unequivocal psychiatric morbidity, and suggest that a response to treatment can be seen after a short trial of GH therapy. We hypothesise that this rapid improvement of symptoms of atypical depression represents a direct central effect of GH therapy.European Journal of Endocrinology 151 325-332