Subtle Cognitive Impairments in Patients with Long-Term Cure of Cushing’s Disease

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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.

Section: Discussionmentioning

confidence: 74%

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

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“…Furthermore, CS is associated with morphological changes of the brain (including brain atrophy, reduction in total and cortical grey matter and reduced hippocampal volume), which at least partially persist after long-term remission (32,33). This may explain the chronic cognitive impairments described in patients in long-term remission of CS (4,34), which may negatively influence QOL. Other explanations for the impaired QOL could be the previous experience of suffering a severe illness, ineffective coping strategies or illness perceptions (35,36).…”

Section: Discussionmentioning

confidence: 99%

“…Although the Cushingoid phenotype improves after curative treatment, there is accumulating evidence that not all changes in body composition, cardiovascular risk profile and cognitive function are reversible (2,3,4). Furthermore, a number of studies have reported that quality of life (QOL) remains impaired in patients in long-term remission of CS (5,6,7,8,9,10,11,12,13,14).…”

Section: Introductionmentioning

confidence: 99%

Impaired quality of life in patients in long-term remission of Cushing's syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?

Wagenmakers¹,

Netea‐Maier²,

Prins³

et al. 2012

Objective: The determinants that cause impaired quality of life (QOL) in patients in long-term remission of Cushing's syndrome (CS) are unknown. The aim of this study was to get more insight into the patient and disease characteristics related to impaired QOL in these patients. Design: Cross-sectional study. Methods: The QOL of 123 patients in remission of CS (age 52.2G12.0 years, 106 women, duration of remission 13.3G10.4 years, 80% pituitary CS), assessed with seven validated questionnaires, was compared with the QOL of an age-and sex-matched control group (nZ105). To investigate the influence of the aetiology of CS on QOL, patients in remission of pituitary and adrenal CS were compared. Furthermore, the influence of hormonal deficiencies, treatment strategy, duration of remission, gender and age on QOL was investigated. Results: QOL in the total patient group and each patient subgroup was significantly worse on practically all dimensions of questionnaires compared with the control group (P!0.05), except for patients in remission of pituitary CS without hormonal deficiencies who had an impaired QOL on 50% of the QOL dimensions. Subgroup analysis revealed no difference in QOL between different patient groups, especially no difference between patients in remission of adrenal and pituitary CS. Female gender and a shorter duration of remission had a negative influence on QOL in the patient group. Conclusions: QOL remains impaired in patients in long-term remission of CS regardless of aetiology, presence of hormonal deficiencies and treatment strategies. More research is needed to establish the causes.

“…Early treatment might be important to reduce the long-term consequences of hypercortisolism. Indeed, after curing CD, improvement of cardiovascular risk and psychological manifestations is only partial (5,6).…”

Section: Introductionmentioning

confidence: 99%

Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

Khalil

Baudry

Guignat

et al. 2011

Objective: To describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS). Design: Retrospective study in a single center. Patients and methods: We studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined 'overt recurrence', as presence of two classical parameters of excess cortisol (increased midnight -either serum or salivary -and 24 h urinary cortisol (UC)), leading to further specific therapeutic action, and 'mild recurrence', as presence of a single classical parameter, leading to simple surveillance. Results: Of the 101 patients, 21 (20.8%) presented with recurrence, 'mild' or 'overt', during long-term follow-up (median 50.4 months, range 7-99). Recurrence occurred less frequently (16.8 vs 50%, PZ0.02), and later (mean 44.7 months, median 43, range 7-94 vs mean 21.5 months, median 17, range 3-61, PZ0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively. Conclusion: A positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.