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This version published online on November 8, 2005
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2005-1058
A more recent version of this article appeared on February 1, 2006
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*Cushing's Syndrome

Submitted on May 12, 2005
Accepted on October 28, 2005

Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission

John R Lindsay MD, Tonya Nansel PhD, Smita Baid MD, Julie Gumowski RN, and Lynnette K Nieman MD*

Reproductive Biology and Medicine Branch, Division of Epidemiology Statistics & Prevention Research, National Institute of Child Health and Human Development, National Institute of Allergy & Infectious Diseases, Bethesda, Maryland 20892

* To whom correspondence should be addressed. E-mail: niemanl{at}mail.nih.gov.

Cushing's syndrome (CS) is associated with symptoms that may impair Health-related Quality of Life (HRQL).

Methods: We used the SF-36 survey to evaluate HRQL in 23 patients with Cushing's disease (CD) before and after transsphenoidal surgery (TSS; age 42.7 ± 12.0 y, 19F/4M) and in a cross-section of 343 CS patients (48.2 ± 14.1 y, 265F/78M) in remission for up to 25.8 yr after surgery [adrenal (5%); ectopic (6%)]. Z-scores were calculated for SF-36 domains and Physical (PCS) and Mental (MCS) summary scores compared with age- and sex-matched controls (n = 6742).

Results: Active CD was associated with low PCS and MCS scores (P < 0.05). Despite residual post-operative impairment, primarily of physical domains, all HRQL parameters improved after treatment with transsphenoidal surgery (3.2 ± 1.5 y) (P < 0.05). In the cross-section in remission at follow-up there was a small but significant (P < 0.05) impairment of both PCS and MCS. A longitudinal post-operative analysis confirmed stable but impaired HRQL over time. Logistic regression demonstrated that previous pituitary radiation and current glucocorticoid use had little effect on HRQL outcomes.

Conclusion: CS is associated with impaired HRQL, which partially resolves following treatment. At longer-term follow up, however, there is residual impairment of HRQL. Determination of modifiable factors that contribute to impaired HRQL may help reduce the physical and psychosocial burden of disease.




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