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Cushing’s disease: a prospective case-control study of health-related quality of life and cognitive status before and after surgery
- Source :
- Journal of Neurosurgery. :1-11
- Publication Year :
- 2019
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2019.
-
Abstract
- OBJECTIVESome studies have highlighted psychological and neuropsychological difficulties and a potential reduction in health-related quality of life (HRQOL) in patients with pituitary tumors, despite hormone deficits or excess. To the authors’ knowledge, this study is the first prospective longitudinal case-control study with the aim of simultaneously testing whether HRQOL and psychiatric and neuropsychological disabilities are related to neural dysfunction due to hypercortisolism per se, or tumor mass and/or surgery in patients with Cushing’s disease (CD). The authors evaluated a homogeneous cohort of patients with CD and nonfunctioning pituitary adenomas (NFPAs) before and after neurosurgery and compared these patients with healthy controls.METHODSTwenty patients (10 with NFPA and 10 with CD) were evaluated using 3 validated questionnaires (SF-36, Beck Depression Inventory–II [BDI-II], and Minnesota Multiphasic Personality Inventory–II [MMPI-II]) to assess HRQOL and psychological status preoperatively and 12 months after neurosurgery. Neuropsychological tests were assessed preoperatively, 3–7 days postoperatively, and 12 months postoperatively. Twenty healthy matched controls were recruited.RESULTSPreoperatively, the NFPA and CD subgroups had worse HRQOL scores than controls on the basis of SF-36 scores, although the NFPA subgroup experienced significant recovery 12 months postoperatively. Preoperatively, CD patients had depressive symptoms according to the BDI-II and MMPI-II that persisted 12 months postoperatively, together with social introversion and hypochondriasis; NFPA patients were similar to controls except for hypochondriasis scores that were clinically significant at all timepoints. Preoperatively and 3–7 days postoperatively, both subgroups showed significant neuropsychological disabilities compared with controls, but only the CD subgroup did not completely recover over time.CONCLUSIONSHRQOL and neuropsychological impairments were observed in all patients at early timepoints, independent of hypercortisolism, tumor mass, and successful surgery. Over time, CD patients showed persistent changes in HRQOL, in particular in social activities. In this light, CD seems to have a strong impact on HRQOL and to be associated with more psychological and neuropsychological comorbidities than NFPA.
- Subjects :
- NFPA = nonfunctioning pituitary adenoma
medicine.medical_specialty
prospective case-control study
BDI-II = Beck Depression Inventory–II
pituitary adenoma
03 medical and health sciences
0302 clinical medicine
Quality of life
Minnesota Multiphasic Personality Inventory
medicine
endoscopic transsphenoidal surgery
neuropsychological evaluation
Depression (differential diagnoses)
TMT = Trail Making Test
CD = Cushing’s disease
hypercortisolism
business.industry
Case-control study
Neuropsychology
General Medicine
Cushing's disease
HRQOL = health-related quality of life
medicine.disease
MMPI-II = Minnesota Multiphasic Personality Inventory–II
pituitary surgery
quality of life
Surgery
030220 oncology & carcinogenesis
Cohort
Neurosurgery
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 19330693 and 00223085
- Database :
- OpenAIRE
- Journal :
- Journal of Neurosurgery
- Accession number :
- edsair.doi.dedup.....5de55f1bea61a58b88cdd09eb257443d