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Submitted on July 15, 2004
Accepted on February 22, 2005
Departments of Endocrinology, Leiden University Medical Center, Leiden, and Erasmus Medical Center, Rotterdam, The Netherlands
* To whom correspondence should be addressed. E-mail: j.a.romijn{at}lumc.nl.
To evaluate the long-term impact of cured Cushing's disease on subjective well being, we assessed quality of life by validated health-related questionnaires in 58 patients cured from Cushing's disease by transsphenoidal surgery (n = 58), some of whom received additional radiotherapy (n = 11) and/or bilateral adrenalectomy (n = 3). The mean duration of remission was 13.4 ± 6.7 yr (range 2 - 25 yr). Patient data were compared with a control group of 98 healthy subjects with the same age and sex distribution, and with age-adjusted reference values available from the literature.
General perceived well being, measured by the Nottingham Health Profile (NHP) and the Short Form (SF-36), was reduced compared with controls for all subscales (P < 0.001). Patients with Cushing's disease had worse scores on subscales of fatigue (Multidimensional Fatigue Index: MFI-20), anxiety and depression (Hospital Anxiety and Depression Scale). Compared with reference values from the literature, quality of life was also reduced in the patients according to all questionnaires and all items, except pain (SF-36), sleep (NHP) and reduced activity (MFI-20). Despite conventional hormone replacement therapy, hypopituitarism was an important independent predictor of reduced quality of life. Patients without hypopituitarism (n = 28) showed reduced scores on physical items, but normal scores on mental items compared with controls.
In conclusion, despite long term cure of Cushing's disease, patients experience a considerable decrease in quality of life, with physical and psychosocial impairments, especially in the presence of hypopituitarism.
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