Increased Prevalence of Psychopathology and Maladaptive Personality Traits after Long-Term Cure of Cushing’s Disease

Objectives: Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. Design: A cross-sectional case-control study. Setting: Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. Participants: Patients with pituitary adenomas (nZ247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (nZ757). Measurements: Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off-and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. Statistical analyses: General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. Results: Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73G0.19) and sleep (PSQI score: 6.75G4.17) as well as increased rates of depression (subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79G0.18, PSQI score: 5.66G4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. Conclusions: These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate goal to improve QoL in patients with pituitary adenomas.

Section: Clinical Study S M Leistner and Others Qol In Patients With contrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas

Leistner

Klotsche

Dimopoulou

et al. 2015

“…This has already been observed in multiple other medical conditions (24). This relationship is a relevant observation, since patients with longterm cure of CS have persistent complaints reflected in impaired QoL (3)(4)(5). These complaints are often misunderstood and difficult to treat.…”

Section: Discussionmentioning

confidence: 74%

“…Following successful treatment of hypercortisolism, signs and symptoms improve substantially. However, prolonged, excessive exposure to glucocorticoids may have long-lasting adverse effects on behavioral and cognitive functions, due to functional and structural alterations in specific brain target areas (1)(2)(3)(4). Furthermore, these patients do not completely return to their premorbid level of functioning, and quality of life (QoL) is persistently impaired despite long-term cure of CS (5).…”

Section: Introductionmentioning

confidence: 99%

Negative illness perceptions are associated with impaired quality of life in patients after long-term remission of Cushing's syndrome

Tiemensma¹,

Kaptein²,

Pereira³

et al. 2011

Self Cite

Objective: Illness perceptions pertain to the pattern of beliefs patients develop about their illness. Illness perceptions are determinants of quality of life (QoL). Factors contributing to persisting impaired QoL after Cushing's syndrome (CS) remain largely unknown. Therefore, the objective of this study was to explore illness perceptions, as potentially modifiable psychological factors, in relation to QoL in patients with long-term remission of CS. Design: Cross-sectional study. Methods: We included patients with long-term remission of CS (nZ52). Illness perceptions were evaluated using the Illness Perception Questionnaire (IPQ)-Revised, and QoL was measured using the physical symptom checklist, EuroQoL-5D (EQ-5D), and the CushingQoL. Reference data were derived from recent studies and included patients with vestibular schwannoma (nZ80), acute (nZ35) or chronic (nZ63) pain, and chronic obstructive pulmonary disease (COPD; nZ171). Results: Illness perceptions showed a strong correlation with QoL. Patients with CS scored distinctively more negative on the IPQ compared with patients with vestibular schwannoma and patients with acute pain, and also reported more illness-related complaints (all P!0.01). There were also some differences in illness perceptions between patients with CS and patients with chronic pain and patients with COPD, but there was no distinct pattern. Conclusions: Patients after long-term remission of CS report more negative illness perceptions compared with patients with other acute or chronic conditions. Further research is needed to assess whether QoL in CS can be improved by addressing these illness perceptions, for example, by a self-management intervention program.

“…A higher prevalence of 'maladaptive' personality traits in CS patients even after long-term cure may affect their everyday QoL (69). They appear to perceive that they are characterized by 'unpleasant' increased anxiety traits (pessimism, neuroticism, shyness with strangers and low extraversion), and try to answer in a rather 'pleasant' (or socially desirable) way.…”

Section: Cushing's Diseasementioning

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.