Coping Strategies in Patients after Treatment for Functioning or Nonfunctioning Pituitary Adenomas

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.

Section: Discussionmentioning

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

“…Increased psychopathology (mainly anxiety and depression), maladaptative personality traits or less effective coping strategies have been described in patients with controlled acromegaly, which in turn may affect cognition and QoL (2,33,34,35,36) (Fig. 1).…”

Section: Acromegalymentioning

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.

“…patients with pituitary disease and adrenal sufficiency) showed mutually the same impairments in psychological variables as the SAI patients, even though SAI patients also suffered from a more pronounced pituitary insufficiency. Nevertheless, given accumulating evidence that standard replacement regimens fail to completely restore quality of life in AI (1) and that patients with AI are at risk for severe affective disorders (3), clinicians should routinely screen their patients for psychiatric symptoms and/or psychological distress and may consider supportive psychosocial interventions (19,20).…”

Section: Sai Patients (Nz18)mentioning

confidence: 99%

“…The only study in patients with secondary AI (SAI) thus far (6) could not detect an effect of different HC dosages (i.e. 15,20, and 30 mg/day) on subjective well-being. This may, however, be attributable to the small sample size of nine SAI patients and/or the comparatively short treatment period of 2 weeks.…”

Section: Introductionmentioning

confidence: 99%

Effects of standard glucocorticoid replacement therapies on subjective well-being: a randomized, double-blind, crossover study in patients with secondary adrenal insufficiency

Benson¹,

Neumann

Unger

et al. 2012

Objective: For secondary adrenal insufficiency (SAI), established biochemical parameters for dosage control are lacking and no optimal substitution dosage and daily distribution have been determined yet. Therefore, in clinical practice, the individual total dose is often adjusted based on patients' subjective well-being. Design: Effects of three standard glucocorticoid replacement regimens on psychological variables were assessed in patients with SAI based on a randomized double-blind study design. Methods: SAI patients (nZ18) were treated with three different established glucocorticoid replacement regimens in a randomized, double-blind, crossover study (treatment A, hydrocortisone 10 mg-placebo-5 mg-placebo; treatment B, hydrocortisone 10 mg-5 mg-placebo-5 mg; and treatment C, prednisone 5 mg-placebo-placebo-placebo). Following each 4-week replacement regimen, quality of life (SF-36) and emotional distress (brief symptom inventory (BSI)) were assessed along with diurnal changes in current well-being (Bf-S) and alertness (Stanford Sleepiness Scale (SSS)) using validated questionnaires, and additionally compared with patient (patients with pituitary disease and adrenal sufficiency) and healthy control groups. Results: SAI patients showed improvements in physical quality of life (i.e. SF-36 physical function, P!0.05; physical role function, P!0.05) and current well-being (at 1800 h, P!0.05) under treatment A (hydrocortisone 10-0-5-0 mg) compared with the other replacement regimens. Quality of life and current well-being were significantly impaired compared with healthy controls but did not differ from patient controls. Conclusions: Although the observed improvements in psychological parameters were comparatively small, our results indicate beneficial effects of a 10-0-5-0 mg hydrocortisone replacement regimen. Nevertheless, treatment effects were insufficient to restore subjective health compared with healthy controls, indicating the need for improved replacement regimens and supportive psychosocial interventions in SAI patients.