Quality of Life in Patients With Cushing's Disease

Abstract

Cushing's disease (and by extension, Cushing's syndrome) is a rare disease due to a chronic cortisol excess, which usually has an important impact on quality of life (QoL). It can lead to numerous comorbidities that can interfere with daily life, as fatigability, myopathy, bone loss and fragility, increased cardiovascular risk, depression, and cognitive alterations. Of note, psychological alterations (including depression and anxiety) occur often, and are an important determinant of impaired quality QoL. QoL scores using different questionnaires are poorer in comparison to healthy controls, other pituitary adenomas and some chronic diseases. Even if some improvements can be observed after successful treatment, recovery does not seem to be complete, and comorbidities persist. This persistent QoL impairment has been found using both generic and disease-specific QoL questionnaires, and is also reported by the patients themselves, when asked directly. Multidisciplinary teams are essential to improve patients' well-being. Clinicians should take into account the whole scope of clinical problems and address the different comorbidites associated with the disease. Screening in the psychological sphere, with further intervention if necessary, can be helpful in the management of these patients. Interventions and programs have shown promising results, although there is a need for further development of new strategies for the benefit of these patients.

Quality of Life and Sleep in Patients with Pituitary Adenoma in Relation to Tumor Type and Compression of the Optic Chiasm

“…In our cohort, a significant improvement in QoL occurred only in patients with Cushing’s disease and it concerned GH, VT, and MH. It is well known that patients with Cushing’s disease experience serious mental and physical problems and, according to studies, have the lowest QoL of all PA patients [ 27 ]. Postsurgical remission rates of Cushing’s disease range from 25 to 100%, with a mean remission rate of 77.8% [ 28 ].…”

Psychiatric and neurocognitive consequences of endogenous hypercortisolism

“…Patients with CS have consistently been found to have impaired QoL, both before and after treatment, and both when evaluated with generic as well as with disease‐specific questionnaires [38,66]. Many of the adverse effects of hypercortisolism on the brain, such as depression [12,67,68], anxiety [68,69], negative illness perception [70] and poor coping strategies [71,72], have indeed been identified as major determinants of the poor QoL [73].…”

“…Some of the factors that are associated with poor QoL in patients with CS, such as depression and anxiety, are modifiable [73]. Also, influencing the illness perceptions and coping strategies of patients with CD may be beneficial [70‐72].…”

Decreased Trabecular Bone Score in Patients With Active Endogenous Cushing’s Syndrome

“…Excess cortisol secretion leads to a typical clinical presentation with all components of metabolic syndrome (diabetes mellitus, dyslipidemia, central obesity, and hypertension) as well as osteoporosis, muscle weakness, menstrual irregularities, and psychiatric dysfunction (4,5). The occurrence of comorbidities including structural and functional alterations of the skeletal system is a relevant cause of increased mortality and impaired quality of life (6,7). Osteoporosis is an underestimated and serious complication of endogenous CS with the prevalence ranging from 31.6% to approximately 50% among published studies (7)(8)(9).…”