Long-Term Impaired Quality of Life in Cushing’s Syndrome despite Initial Improvement after Surgical Remission

Lindsay, John R.; Nansel, Tonja R.; Baid, Smita; Gumowski, Julie; Nieman, Lynnette K.

doi:10.1210/jc.2005-1058

Cited by 189 publications

(170 citation statements)

References 26 publications

Supporting

Mentioning

153

Contrasting

Unclassified

Order By: Relevance

“…For example, patients with Cushing's disease demonstrate persistent challenges in health-related QOL. 10 We did compare sinonasal QOL in patients with functioning tumors to that in patients with nonfunctioning tumors and did not note a significant difference. Furthermore, in the multivariate model, the presence of functioning tumor was not a predictor of sinonasal QOL (Table 3).…”

Section: Discussionmentioning

confidence: 94%

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Little

Kelly

Milligan

et al. 2015

JNS

View full text Add to dashboard Cite

OBJECT Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence. CONCLUSIONS Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.

show abstract

Section: Discussionmentioning

confidence: 94%

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Little

Kelly

Milligan

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…QoL has previously been shown to be impaired in patients with controlled Cushing's disease (6,7,17,18). However, only two studies have taken the possible role of GHD into account (6,7).…”

Section: Analysis Bmentioning

confidence: 99%

Clinical features of GH deficiency and effects of 3 years of GH replacement in adults with controlled Cushing's disease

Höybye¹,

Ragnarsson²,

Jönsson³

et al. 2010

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Patients in remission from Cushing's disease (CD) have many clinical features that are difficult to distinguish from those of concomitant GH deficiency (GHD). In this study, we evaluated the features of GHD in a large cohort of controlled CD patients, and assessed the effect of GH treatment. Design and methods: Data were obtained from KIMS, the Pfizer International Metabolic Database. A retrospective cross-sectional comparison of background characteristics in unmatched cohorts of patients with CD (nZ684, 74% women) and nonfunctioning pituitary adenoma (NFPA; nZ2990, 39% women) was conducted. In addition, a longitudinal evaluation of 3 years of GH replacement in a subset of patients with controlled CD (nZ322) and NFPA (nZ748) matched for age and gender was performed. Results: The cross-sectional study showed a significant delay in GHD diagnosis in the CD group, who had a higher prevalence of hypertension, fractures, and diabetes mellitus. In the longitudinal, matched study, the CD group had a better metabolic profile but a poorer quality of life (QoL) at baseline, which was assessed with the disease-specific questionnaire QoL-assessment of GHD in adults. After 3 years of GH treatment (mean dose at 3 years 0.39 mg/day in CD and 0.37 mg/day in NFPA), total and low-density lipoprotein cholesterol decreased, while glucose and HbAlc increased. Improvement in QoL was observed, which was greater in the CD group (K6 CD group versus K5 NFPA group, P!0.01). Conclusion: In untreated GHD, co-morbidities, including impairment of QoL, were more prevalent in controlled CD. Overall, both the groups responded similarly to GH replacement, suggesting that patients with GHD due to CD benefit from GH to the same extent as those with GHD due to NFPA.

show abstract

“…These clinical improvements are very important to the patien- t's quality of life, once it represents the return to normal activities. Some studies suggest that even cured patients might continue to have a poor quality of life (43)(44)(45)(46). Possible explanations for this observation are the definitive systemic damage caused by CD or are associated to the poor biochemical criteria adopted.…”

Section: Clinical Featuresmentioning

confidence: 99%

Criteria of cure and remission in Cushing's disease: an update

Czepielewski

Rollin

Casagrande

et al. 2007

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

We review the clinical and biochemical criteria used for evaluation of the transsphenoidal pituitary surgery results in the treatment of Cushing's disease (CD). Firstly, we discuss the pathophysiology of the hypothalamic-pituitary-adrenal axis in normal subjects and patients with CD. Considering the series published in the last 25 years, we observed a significant variation in the remission or cure criteria, including the choice of biochemical tests, timing, threshold values to define remission, and the interference of glucocorticoid replacement or previous treatment. In this context we emphasize serum cortisol levels obtained early (from hours to 12 days) in the postoperative period without any glucocorticoid replacement or treatment. Our experience demonstrates that: (i) early cortisol < 5 to 7 µg/dl, (ii) a period of glucocorticoid dependence > 6 mo, (iii) absence of response of cortisol/ACTH to CRH or DDAVP, (iv) return of dexamethasone suppression, and circadian rhythm of cortisol are appropriate indices of remission of CD. In patients with undetectable cortisol levels early after surgery, recurrence seems to be low. Finally, although certain biochemical patterns are more suggestive of remission or surgical failure, none has been proven to be completely accurate, with recurrence observed in approximately 10 to 15% of the patients in long-term follow-up. We recommended that patients with CD should have long-term monitoring of the CRH-ACTH-cortisol axis and associated co-morbidities, especially hypopituitarism, diabetes mellitus, hypertension, cardiovascular disturbances, and osteoporosis. RESUMOCritérios de Cura e Remissão na Doença de Cushing: Uma Atualização. Neste artigo, são revisados os principais critérios clínicos e hormonais utilizados para avaliação do tratamento cirúrgico da Doença de Cushing (DC). Inicialmente são comentados aspectos fisiopatológicos que orientam a avaliação hormonal e os principais fatores clínicos, laboratoriais, cirúrgicos e histológicos associados com melhores resultados, observados nas principais séries da literatura e em pacientes acompanhados prospectivamente pelos autores. Foram revisados, também, critérios adotados nas principais séries da literatura, nos últimos 25 anos, chamando-se atenção para as dosagens hormonais, o momento em que foram realizadas, a possibilidade de interferência de tratamentos prévios e da reposição glicocorticóide. À seguir, essas dosagens são discutidas salientando-se a importância do cortisol obtido seqüencialmente no pós-operatório e sem a interferência de reposição glicocorticóide. A experiência prospectiva dos autores, recentemente referendada na literatura, demonstra que valores de cortisol < 5 a 7 µg/dl associados com um período de dependência aos glicocorticóides > 6 meses, ausência de resposta do ACTH/cortisol ao DDAVP e/ou CRH, retorno da supressão à dexametasona e do ritmo circadiano, estão associados com remissão da DC. Em pacientes com cortisol indetectável após cirurgia transesfenoidal, a chance de recidiva parece ser menor d...

show abstract

Long-Term Impaired Quality of Life in Cushing’s Syndrome despite Initial Improvement after Surgical Remission

Abstract: CS is associated with impaired HRQL, which partially resolves after treatment. At longer-term follow-up, however, there is residual impairment of HRQL. Determination of modifiable factors that contribute to impaired HRQL may help reduce the physical and psychosocial burden of this disease.

Cited by 189 publications

References 26 publications

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Clinical features of GH deficiency and effects of 3 years of GH replacement in adults with controlled Cushing's disease

Criteria of cure and remission in Cushing's disease: an update

Contact Info

Product

Resources

About