Abstract
Background: Patients suffering from Cushing’s disease are known to be restricted due to a wide
range of symptoms. Despite biochemical cure, symptoms might last life-long. These
include – among well-known somatic symptoms – several neuropsychiatric symptoms that
cannot be as easily tested, but lead to a serious negative impact on quality of life.
We aimed to evaluate what factors diminish the self-perceived quality of life the
most using 3 questionnaires visualizing those impairments. Furthermore we investigated
whether there would be differences in quality of life between patients still being
affected by the disease and those that are already in remission.
Patients and Methods: We reviewed patient charts treated between April 2008 and June 2012 for Cushing’s
disease and sent 3 questionnaires to the patients for evaluation. For this purpose
we used the SF-36, the BDI and the Tuebingen CD-25. 54 patients complied with our
request and returned the completed questionnaires. The average time after surgery
was 36 months.
Results: In all 8 dimensions of the SF-36 significant differences between the patient collective
and the expected age- and gender-specific scores could be observed and thus a detectable
impairment in quality of life. The BDI revealed that every other patient suffering
from Cushing’s disease presented depressive symptoms, partially with clinical relevance.
In all 6 dimensions of the Tuebingen CD-25 there were notable restrictions in patients.
Those restrictions particularly concerned bodily restrictions and cognitive performance.
The self-perceived quality of life of active patients was – although not statistically
significant – in almost all measured fields worse than the test results of patients
in remission after TSS.
Conclusion: Former and active Cushing’s disease patients suffer from a wide range of neuropsychiatric
symptoms. Those symptoms might dominate the clinical picture and lead to a serious
impairment in quality of life as well as extend periods of suffering and might persist
even years after being found healthy. Therefore it is important to evaluate quality
of life as an independent factor in every patient being affected by Cushing’s disease
and to include a holistic view in their therapy. Concomitant therapeutic measures
should be accessible at any time for Cushing’s disease patients as the normalization
of pathologically increased laboratory values doesn’t obligatory lead to an improvement
of the patients subjectively felt well-being.
Key words
cushing’s disease - depression - quality of life - remission
