Cushing’s disease: a prospective case-control study of health-related quality of life and cognitive status before and after surgery
| Autor: | Claudia Giavoli, Martina Andrea Sirtori, Elisa Verrua, Paolo Rampini, Anna Spada, Emanuele Ferrante, Elisa Sala, Giulia Del Sindaco, Giulio Bertani, Giulia Carosi, Giovanna Mantovani, Marco Locatelli, Barbara Zarino, Andreea Liliana Serban, Maura Arosio, Giorgio Carrabba |
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| Rok vydání: | 2019 |
| Předmět: |
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 |
| Zdroj: | Journal of Neurosurgery. :1-11 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2019.8.jns19930 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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