Mental fatigue and executive dysfunction in patients with Cushing's syndrome in remission

Papakokkinou, Eleni; Berglund, P.; Johansson, Birgitta; Ragnarsson, Oskar

doi:10.1530/endoabs.37.gp.21.05

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…Even if impairment was still present in comparison to controls, in the group without pituitary deficiencies it was only found in half of the dimensions evaluated (37). Other studies have also found higher fatigue in CS patients in remission than in healthy controls, measured with MFI-20 and MFS (36,79).…”

Section: Effects Of Remission In Quality Of Lifementioning

confidence: 87%

Quality of Life in Patients With Cushing's Disease

et al. 2019

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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.

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Section: Effects Of Remission In Quality Of Lifementioning

confidence: 87%

Quality of Life in Patients With Cushing's Disease

et al. 2019

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“…CS is caused by prolonged overexposure to cortisol. Chronic cortisol exposure affects almost all tissues of the human body, causing a wide range of symptoms, including hypertension, central obesity, gonadal dysfunction, muscle weakness, and osteoporosis [9]. Suffering from CS has been shown to negatively affect physical and psychological health aspects, and thus HRQOL, in affected patients, even after endocrine “cure” [3-5].…”

Section: Discussionmentioning

confidence: 99%

“…Mental fatigue is common in CS patients in remission. The reason for the irreversibility of posttreatment mental fatigue and cognitive dysfunction in CS patients are still unknown to date [9]. Compared to patients treated for nonfunctioning pituitary tumors, patients who remit with CD worsened in terms of specific executive functions and memory and reported higher psychopathological prevalence [20].…”

Section: Discussionmentioning

confidence: 99%

Impact of Adrenalectomy on Cortisol-Producing Adenoma: Longitudinal Evaluation of Health-Related Quality of Life following Laparoscopic Adrenalectomy

et al. 2020

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Introduction: There is increasing interest in evaluating the quality of life of patients with cortisol-producing adrenocortical adenoma (CPA). Our objective was to assess patientreported health-related quality of life (HRQOL) in patients with CPA compared to non-CPA. Methods: Between January 2012 and September 2015, a total of 24 and 62 patients who had laparoscopic adrenalectomy with CPA and non-CPA, respectively, were included in the study. General HRQOL was evaluated on Short Form 8 (SF-8) questionnaire. The SF-8 questionnaire was administered at preoperative baseline and at 3, 6, 9, 12, 18, and 24 months after adrenalectomy. The impact of changing 2 measures of the summary score on the physical component summary (PCS) and mental component summary (MCS) score of SF-8 was evaluated in prospective and longitudinal studies. Results: The baseline PCS score was significantly lower in the CPA than in the non-CPA group (43.6 vs. 49.0; p = 0.0075). Thereafter, the PCS score was significantly lower in the CPA group at 3, 6, 9, and 12 months postoperatively. The PCS score increased in the CPA group with no significant difference between both groups at 18 months (48.1 vs. 50.2; p = 0.1202) and 24 months (48.0 vs. 50.8; p = 0.3625) postoperatively. However, the baseline MCS score was not significantly different between the CPA and non-CPA group. The MCS score in both groups gradually increased with no significant differences between the groups at any time points after surgery. The PCS score was not significantly improved at all postoperative points than the baseline score in the CPA and non-CPA group. The MCS score was significantly improved than the baseline score from 6 months postoperatively only in the CPA group. Conclusion: Our research suggests that laparoscopic adrenalectomy may contribute to improving the physical and mental function in HRQOL.

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“…Finally, Swedish patients, in remission for a median time of 13 years, were found to have higher scores for depression, anxiety and fatigue, compared with controls [13]. In the same cohort, problems due to mental fatigue, stress intolerability, irritability and emotional lability were much more common in patients in remission than in controls [15].…”

Section: Psychiatric Symptomsmentioning

confidence: 99%

Psychiatric and neurocognitive consequences of endogenous hypercortisolism

et al. 2020

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Psychiatric and neurocognitive symptoms due to hypercortisolism were already described by Harvey Cushing in his original paper on patients with Cushing's syndrome (CS). Nowadays, it is well known that psychiatric and cognitive complaints are two of the most common, and most distressing, symptoms in patients with CS. Psychiatric symptoms are indeed a major clinical manifestation of CS. The most commonly observed psychiatric conditions are depression and anxiety, whilst mania and psychosis are less common. Several domains of cognitive function are impaired at diagnosis, including episodic and working memory, executive function and attention. Following treatment, onefourth of the patients still experience depressed mood, and the cognitive impairments are only partially restored. Consequently, quality of life in patients with CS is severely and persistently affected. Neuroimaging studies have also illustrated the deleterious effects of hypercortisolism on the brain by demonstrating reduced grey matter volumes and cortical thickness, altered restingstate functional responses and during cognitive tasks, as well as widespread reduced white matter integrity, especially in structures important for cognitive function and emotional processing, both before and after successful abrogation of hypercortisolism. In this paper, we summarize the current knowledge on the psychiatric and neurocognitive consequences of hypercortisolism in patients with CS, both before, and after successful treatment. In addition, we review the structural and functional brain abnormalities associated with hypercortisolism and discuss the influence of these factors on quality of life.

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Mental fatigue and executive dysfunction in patients with Cushing's syndrome in remission

Cited by 4 publications

References 14 publications

Quality of Life in Patients With Cushing's Disease

Quality of Life in Patients With Cushing's Disease

Impact of Adrenalectomy on Cortisol-Producing Adenoma: Longitudinal Evaluation of Health-Related Quality of Life following Laparoscopic Adrenalectomy

Psychiatric and neurocognitive consequences of endogenous hypercortisolism

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