Tuebingen CD-25 Is a Sensitive Tool to Investigate Health-Related Quality of Life in Cushing's Disease Patients in the Course of the Disease

Abstract

Background: The primary object was to investigate whether the Tuebingen CD-25 captures changes in health-related quality of life (HRQoL) sensitively in Cushing's disease (CD) and to identify factors that favour postoperative HRQoL. Methods: 17 CD patients were scheduled for transsphenoidal tumour removal and filled out the inventory before and after surgery. The mean time elapsed after surgery was 14.4 ± 11.3 months. All patients were in remission at the second timepoint of investigation. Results: HRQoL as assessed with the Tuebingen CD-25 improved significantly after successful surgical tumour removal. A large effect size (Cohen's d = 0.84) in the total score indicates good sensitivity to change. 13 patients (76.5%) showed impaired HRQoL preoperatively compared with a general population sample. Postoperatively, 35.3% of the patients still suffered from an impaired HRQoL. Stepwise linear regression analysis revealed that less comorbidities (≤2) and greater morning cortisol decrease were promotive factors for better postoperative HRQoL (p < 0.05). The postoperative improvement in HRQoL could be best predicted by the presence of preoperative HRQoL impairment and age of the patients, i.e. patients who were younger were more likely to improve. Moreover, patients without postoperative pituitary deficiencies improved significantly more in the cognition scale. A tendency towards more improvement in overall HRQoL was observed in non-hypocortisolaemic patients. Conclusions: The Tuebingen CD-25 has proved to be a capable and sensitive instrument to investigate HRQoL in the course of disease. The number of postoperative comorbidities had the greatest impact on postoperative well-being.

Similar Psychopathological Profiles in Female and Male Cushing's Disease Patients after Treatment but Differences in the Pathogenesis of Symptoms

“…The following independent variables: age, presence of comorbidities, presence of hypocortisolism, presence of hypopituitarism, time to diagnosis, time since surgery and postoperative radiotherapy were included in the model. The rationale of the chosen factors for the regression analyses were that previous studies already discussed effects of hypopituitarism (here also including replacement of glucocorticoids) [17] and comorbidities [18] on either psychiatric status or quality of life in CD. Pituitary radiation was shown to have little [19] or no effect [17,20,21] on quality of life outcomes.…”

“…Only the presence of comorbidities, and in one domain pituitary deficiencies, was associated with psychopathological status, strongly suggesting that the stressors female CD patients have to cope with play the main role in the pathogenesis of psychiatric disorders. In our previous study we identified variables that predict several domains of postoperative quality of life, one of them being depression [18]. We observed in a cohort of 17 patients (of whom 82.4% were female) that postoperative depression scores were best predicted by the number of postoperative comorbidities.…”

Validation of the Tuebingen CD-25 Inventory as a Measure of Postoperative Health-Related Quality of Life in Patients Treated for Cushing's Disease

“…Impairments concerning the HRQoL have been increasingly recognized as an important aspect of clinical management in patients suffering from CD [3], as HRQoL among CD patients is reduced compared to the general population. Approximately 80% of patients with active CD suffer from impairments in HRQoL compared to age- and sex-matched healthy controls [4,5]. Postoperatively, one third of all CD patients continue to suffer from impaired HRQoL despite biochemical remission [5], which is attributed to irreversible effects caused by glucocorticoid excess [6].…”

“…Approximately 80% of patients with active CD suffer from impairments in HRQoL compared to age- and sex-matched healthy controls [4,5]. Postoperatively, one third of all CD patients continue to suffer from impaired HRQoL despite biochemical remission [5], which is attributed to irreversible effects caused by glucocorticoid excess [6]. …”

“…mood, sexual activity, social environment, eating behavior, physical aspects, and cognitive functioning) and provides a total score [10]. The inventory has shown excellent internal consistency (Cronbach's α = 0.94) and a high validity (correlation coefficients between -0.65 and -0.74) [5,10], determined by the correlations between the total score of the Tuebingen CD-25 and the overall score of the established WHO Quality of Life-BREF (WHOQoL-BREF [11]). However, to date, no validity data about the Tuebingen CD-25 against the widely used CushingQoL and the most widely used generic tool for assessing HRQoL, i.e.…”