Cortisol diurnal rhythm and quality of life after successful medical treatment of Cushing's disease
| Autor: | S. W. J. Lamberts, Romana T. Netea-Maier, Leo J. Hofland, A. R. M. M. Hermus, C. de Bruin, Susan M. Webb, Richard A Feelders, Alberto M. Pereira, A. J. van der Lely, Johannes A. Romijn, R. van der Pas, W. W. de Herder, Pierre M. J. Zelissen, F. H. De Jong |
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| Přispěvatelé: | Internal Medicine, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, General Internal Medicine |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Quality of life medicine.medical_specialty Cabergoline Health aging / healthy living [IGMD 5] Hydrocortisone Endocrinology Diabetes and Metabolism Hospital Anxiety and Depression Scale chemistry.chemical_compound Young Adult Endocrinology Internal medicine Surveys and Questionnaires medicine Humans Hormonal regulation Translational research [IGMD 6] Young adult Ergolines Pituitary ACTH Hypersecretion Cortisol diurnal rhythm Aged business.industry Hormonal regulation [IGMD 6] Cushing's disease Middle Aged medicine.disease Pasireotide Circadian Rhythm Nottingham Health Profile Ketoconazole chemistry Dopamine Agonists Physical therapy Female business Somatostatin medicine.drug Medical treatment |
| Zdroj: | Pituitary, 16, 536-44 Pituitary, 16, 4, pp. 536-44 Pituitary, 16(4), 536-544. Kluwer Academic Pituitary r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname Pituitary, 16(4), 536-544. Kluwer Academic Publishers Pituitary, 16(4), 536-544 |
| ISSN: | 1386-341X |
| Popis: | Item does not contain fulltext Cushing's disease (CD) is associated with severely impaired quality of life (QoL). Moreover, the physiological cortisol diurnal rhythm (CDR) is disturbed in CD. QoL can improve after successful surgery, the primary treatment for CD. We evaluated the effects of medical treatment on QoL and CDR. In 17 patients, stepwise medical treatment was applied with the somatostatin analog pasireotide, the dopamine agonist cabergoline and the adrenal-blocking agent ketoconazole. After 80 days, 15/17 (88%) patients had reached normal urinary free cortisol excretion (UFC). Subsequently, patients continued medical therapy or underwent surgery. UFC, plasma and salivary CDR and QoL-related parameters (assessed using 5 questionnaires: Nottingham Health Profile, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Index-20, RAND-36, CushingQoL) were measured. At baseline, 5/17 patients had preserved CDR. In 6/12 patients with disturbed baseline CDR, recovery was observed, but without any correlation with QoL. QoL was significantly impaired according to 18/20 subscales in CD patients compared to literature-derived controls. According to the RAND-36 questionnaire, patients reported more pain at day 80 (p < 0.05), which might reflect steroid-withdrawal. Generally, QoL did not improve or deteriorate after 80 days. CushingQoL scores seemed to improve after 1 year of remission in three patients that continued medical therapy (p = 0.11). CDR can recover during successful pituitary- and adrenal-targeted medical therapy. Patients with CD have impaired QoL compared to controls. Despite the occurrence of side-effects, QoL does not deteriorate after short-term biochemical remission induced by medical therapy, but might improve after sustained control of hypercortisolism. 01 december 2013 |
| Databáze: | OpenAIRE |
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