Psychosocial impairment in patients treated for pituitary disease: a controlled study

Sonino, Nicoletta; Ruini, Chiara; Navarrini, Cecilia; Ottolini, Fedra; Sirri, Laura; Paoletta, Agostino; Fallo, Francesco; Boscaro, Marco; Fava, Giovanni A.

doi:10.1111/j.1365-2265.2007.02951.x

Cited by 48 publications

(68 citation statements)

References 52 publications

(114 reference statements)

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“…The emotional and psychological effects of such lingering changes have so far not been thoroughly studied. Previous studies have reported an increased risk of psychopathology and maladaptive personality traits in patients with active acromegaly and those who have been in long-term remission (8,21,22). However, to date there has been no satisfactory explanation of this phenomenon except that it may be related to irreversible changes associated with previous GH excess (8).…”

Section: Discussionmentioning

confidence: 78%

Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

Imran

Tiemensma

Kaiser

et al. 2016

European Journal of Endocrinology

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Objective: Acromegaly is frequently associated with altered facial appearance at the time of diagnosis. Furthermore, acromegaly is also associated with adverse psychological outcomes. We conducted a single-centre, cross-sectional study comparing patients with growth hormone vs non-functioning pituitary adenomas (NFA) to assess the association between morphometric changes and psychological outcomes and illness perception of patients with acromegaly. Methods: A seven-step scale was developed to grade morphometric changes based on facial photographs. In addition, all patients were asked to draw an image of their own body and an image of what they considered to be an average healthy body and complete seven psychological questionnaires. We recruited 55 consecutive patients in each of the two groups who had undergone surgery with or without radiation therapy (RT). Results: Our data showed that the clinician-rated morphometric scale was highly reliable in assessing facial changes, with 93/99 (Intraclass correlation coefficient (ICC)Z0.95 (0.93-0.97)) graded as similar by independent raters. The mean (S.D.) grading for Acro and NFA patients on the clinician-rated morphometric scale were 3.5 (1.3) and 0.41 (0.35) respectively (P!0.0001). A higher clinician-rated morphometric score was also predictive of a poorer score on the drawing test. Conclusions: Our study demonstrates a correlation between physical changes associated with acromegaly and poor psychological outcomes, whereas no such correlation existed with modes of therapy, disease control status, RT, malignancy, initial or recent GH/IGF1 or secondary hormonal deficiency. Our data support the utility of the morphometric scale as a clinical tool for grading facial changes.

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Section: Discussionmentioning

confidence: 78%

Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

Imran

Tiemensma

Kaiser

et al. 2016

European Journal of Endocrinology

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“…Glucocorticoid dose has to be tapered after successful surgery, but this is challenging for some patients who just cannot tolerate dose reduction, even several weeks or months after the surgery. Even in the long-term management of CS, being aware of these changing situations does help patients conform, with the hope of final improvement (5). Common complaints like cognitive impairments and psychiatric disorders, as well as periodic follow-ups to evaluate pituitary function and detect possible recurrences of hypercortisolism, put extra stress on these CS patients, which in turn worsens psychological issues and often leads to a bad QoL.…”

Section: Cushing's Diseasementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Webb

Crespo

Santos

et al. 2017

European Journal of Endocrinology

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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.

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“…The application of the DCPR operational criteria has permitted to document the occurrence of demoralization across different medical settings, substantiating previous findings that used dimensional tools 20, 21 . In studies utilizing the DCPR, demoralization was found in 14-44% of patients with cardiac 22 , oncological 23 , dermatological 24 , gastrointestinal 25 and endocrine conditions [26][27][28] , in those recruited in primary care 29 and in consultation-liaison psychiatry settings 30,31 . Table 1 DCPR criteria for demoralization A through C are required A.…”

Section: Introductionmentioning

confidence: 99%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

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ITALY ABSTRACT -Background and Objectives:There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill.Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis.Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSM-IV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder.Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

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Psychosocial impairment in patients treated for pituitary disease: a controlled study

Cited by 48 publications

References 52 publications

Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

Morphometric changes correlate with poor psychological outcomes in patients with acromegaly

MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Subtyping demoralization in the medically ill by cluster analysis

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