Predictors of Quality of Life in Patients with Treated Cushing's Disease

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-93
Alessia Carluccio*1, Nina K. Sundaram2, Sumedha Chablani2, Levana G. Amrock2, Jessica K. Lambert2, Kalmon D. Post2 and Eliza B. Geer2
1Mount Sinai Medical Center, New York, NY, 2Icahn School of Medicine at Mount Sinai, New York, NY
Background: Prolonged exposure to glucocorticoids in Cushing’s Disease (CD) is associated with significant physical and psychological impairment. Despite treatment, many patients have persistent reductions in quality of life (QoL). Identifying predictors of QoL is paramount to the comprehensive long-term management of these patents.

Objective: To evaluate and identify predictors for QoL in patients with treated CD.

Methods: A retrospective chart review was conducted of 362 patients who underwent transsphenoidal surgery for CD by a single surgeon. Ninety-three patients (73 women, 20 men, mean age at follow up 50.3 ± 14.7 years, mean time since surgery 7.55 ± 6.03 years) were contacted by phone to complete four mail-in surveys, including a medical history questionnaire and three validated quality of life assessments: Cushing’s QoL Questionnaire (CushingQoL), Hospital Anxiety and Depression Scale (HADS), and Nottingham Health Profile (NHP). Patients were divided into self-identified remission (N=75) and persistent disease (N=18) groups. Mean QoL scores were compared between the two groups with unpaired t-tests. Pearson’s correlation was performed in the whole cohort to assess for predictors of impaired QoL.

Results: Patients with treated CD experienced poor energy (57%), memory (48%) and concentration (43%), difficulty losing weight (49%), anxiety (43%) and depression (34%). Mean CushingQoL score was 57.2 ± 22.6 (0 = worst, 100 = best). When compared to patients with persistent disease, those in remission reported greater CushingQoL (p=0.005) and less depression (p=0.015) but had higher levels of anxiety (p=0.039). BMI negatively correlated with CushingQoL (p=0.009) but positively correlated with general health (p=0.0001). Recovery duration negatively correlated with CushingQoL (p=0.004) and positively correlated with depression (p=0.005) and general health (p=0.002).

Conclusions: Even after treatment, patients with CD reported persistent physical and psychological limitations. Self-assessed remission was associated with less depression but more anxiety compared to persistent disease. Recovery duration, although often viewed as a marker of successful treatment, was associated with reduced QoL and greater depression. These parameters may be helpful in identifying at-risk subgroups for psychological comorbidities. Continued evaluation of QoL and its predictors is needed to better understand paradoxical QoL changes that occur in treated CD patients.


Nothing to Disclose: AC, NKS, SC, LGA, JKL, KDP, EBG

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: NIH Grant K23 DK 082617 awared to EBG; National Center for Research Resouces Grant TL1TR000068.