Patient-Centered Outcomes with Pituitary and Parasellar Disease

Webb, Susan M.; Santos, Alicia; Aulinas, Anna; Resmini, Eugenia; Martel, Luciana; Martínez-Momblán, Ma Antonia; Valassi, Elena

doi:10.1159/000506809

Cited by 14 publications

(11 citation statements)

References 22 publications

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“…Increased duration of opioid use was also associated with a history of anxiety and depression. Compared with the healthy population, patients with pituitary adenomas have higher rates of anxiety and depression than the general population, and these illnesses persist even after surgical intervention 15,16 . Similarly, patients with other anterior skull base neoplasms, such as meningiomas and olfactory neuroblastoma, also have increased rates of comorbid anxiety and depression 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the healthy population, patients with pituitary adenomas have higher rates of anxiety and depression than the general population, and these illnesses persist even after surgical intervention. 15,16 Similarly, patients with other anterior skull base neoplasms, such as meningiomas and olfactory neuroblastoma, also have increased rates of comorbid anxiety and depression. 17,18 This higher prevalence of anxiety and depression in the ESBS population may influence postoperative opioid use.…”

Section: F I G U R Ementioning

confidence: 99%

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Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Rimmer

Scott

Pailet

et al. 2021

Int Forum Allergy Rhinol

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Background Opioid abuse is a public health crisis and the perioperative period can be a time of first opioid exposure. Little is known about postoperative pain management after endoscopic skull base surgery (ESBS). Methods This investigation was a single‐institution, longitudinal, prospective cohort study of adult patients undergoing ESBS between November 2019 and March 2020. Participants completed preoperative questionnaires and were contacted every 48 hours postoperatively to quantify pain and opioid consumption. Results A total of 33 patients were enrolled and 28 of 33 patients (85%) underwent ESBS for sellar pathology. Mean total morphine milligram equivalents (MME) consumed was 381.9 ± 476.0. History of a headache disorder (p = 0.025) and previous opioid use within 60 days preoperatively (p < 0.001) were significantly associated with greater opioid use. Mean duration of opioid use was 6.7 ± 5.1 (range, 0‐20) days. Headache disorder (p = 0.01), depression (p = 0.03), anxiety (p = 0.03), age ≤46 years (p = 0.029), and previous opioid use (p = 0.008) were all associated with longer mean opioid use. Patients with headache disorder also reported higher mean postoperative pain scores. Fewer than half of the participants required opioids by postoperative day 8. Prescription of nonsteroidal anti‐inflammatory drugs at discharge was significantly associated with less outpatient opioid use (p = 0.032). At 2‐month follow‐up, 37% of patients reported keeping excess opioids. Conclusion After ESBS, greater total opioid use was significantly associated with history of headaches and previous opioid use within 60 days. Overall, opioid use declined among all patients in the postoperative period, but several factors may contribute to longer duration of use.

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Section: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 99%

Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Rimmer

Scott

Pailet

et al. 2021

Int Forum Allergy Rhinol

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“…Eight relatives considered the patient to have a very low or low self-esteem (vs. 6 when completed by the patient), while 13 (vs. 12 when fulfilled by the patient) considered the patient to have a high or very high self-esteem (p=0.348). We asked every relative to depict the Stunkard body that would be given by the patient: the median estimated Stunkard body score was 5 [1][2][3][4][5][6][7][8], which was not significantly different compared to the patient's answers (p= 0.171 in comparison with the patient). The same non-significant difference was observed for the IBQ (p=0.549).…”

Section: Resultsmentioning

confidence: 94%

“…In chronic diseases, health-related quality of life has become an increasingly important aspect of patient care [1]. For instance, patients with active as well as controlled acromegaly report an impaired quality of life, linked to the duration of the disease, the necessity of a prolonged medical treatment, a history of radiotherapy or persistent symptoms such as joints complaints [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Acromegaly in remission: a view from the partner

Fourneaux

Vermalle

Albarel

et al. 2021

European Journal of Endocrinology

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Background A relative can be an asset in dealing with chronic illnesses, such as acromegaly, where quality of life is altered even after remission. However, it has been shown that quality of life of caregivers can also be impacted. Our main objective was to compare the perception of acromegaly in remission in the patient-relative dyad. Methods In this observational study, 27 patients in remission and relatives were first asked to complete quality of life, anxiety/depression and coping strategy questionnaires. Then, the patient’s body image and self-esteem were evaluated from both the patient’s and from the relative’s point of view using the same questionnaires with modified instructions. Results Relatives had overall an accurate estimation of patient body image using the Figure Rating Scale by Stunkard. However, there were wide variations between the patient’s and the relative’s responses regarding self-esteem and body perception. The quality of life of relatives was not altered and was significantly higher in the social domain than for the patient. Conclusions Our results show that relatives require education concerning all the steps involved in the management of acromegaly, as they likely do not fully understand the sequelae of acromegaly.

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“…A longitudinal study in Sweden found that a longer diagnostic delay (defined as the time between the first onset of comorbidity and the diagnosis of acromegaly) led to increased mortality and a greater number of comorbidities ( 9 ). Other than physical health, delayed diagnosis may also have a negative impact on the quality of life and psychosocial functions of daily life ( 10 , 11 ). Therefore, early diagnosis is essential for the future health status of patients with acromegaly ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Patient-Identified Problems and Influences Associated With Diagnostic Delay of Acromegaly: A Nationwide Cross-Sectional Study

Wang

Guo

et al. 2021

Front. Endocrinol.

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BackgroundInsidious-onset acromegaly may easily be overlooked by non-specialists of acromegaly and cause diagnostic delay. This study aims to examine the association between diagnostic delay and advice from doctors before any confirmed diagnosis and subsequent comorbidities, and elicit patient-perceived reasons for misdiagnoses.MethodsAn online nationwide cross-sectional study was conducted through China Acromegaly Patient Association. Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-1) levels at diagnosis and cancerous, endocrine-metabolic, musculoskeletal, cardiovascular, respiratory, and psychiatric comorbidities were reported by patients. The association between diagnostic delay and pre-diagnostic advice from doctors as well as subsequent comorbidities after diagnosis were examined.ResultsIn total, 447 valid responses were collected. Overall, 58.8% patients experienced misdiagnoses, and 22.6% had diagnostic delay. Before arriving at any diagnosis, patients without treatment (adjusted odds ratio [AOR]: 3.66, 95% confidence interval [CI]: 1.30-10.33) or receiving treatment to symptoms only (AOR: 7.05, 95%CI: 4.09-12.17) had greater chance of being misdiagnosed, and hence had diagnostic delay. Patients believed insufficient specialists, limited awareness of acromegaly of non-specialists and poor doctor-patient communications were major reasons of misdiagnosis. Diagnostic delay were associated with higher GH level at diagnosis and endocrine-metabolic, musculoskeletal and cardiovascular comorbidities (all P<0.05).ConclusionsSuboptimal pre-diagnostic advice for patients, reflecting limited awareness of acromegaly among non-specialists, may delay the diagnosis and increase comorbidities. Feedbacks on the patients’ final diagnosis from specialists to non-specialists should be considered, and doctor-patient communication and clinical decision-making process should be improved. Comorbidities should be screened and monitored particularly for patients with diagnostic delay.

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Patient-Centered Outcomes with Pituitary and Parasellar Disease

Cited by 14 publications

References 22 publications

Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Acromegaly in remission: a view from the partner

Patient-Identified Problems and Influences Associated With Diagnostic Delay of Acromegaly: A Nationwide Cross-Sectional Study

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