Cushing’s disease: a prospective case-control study of health-related quality of life and cognitive status before and after surgery

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OBJECTIVE

Some 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.

METHODS

Twenty 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.

RESULTS

Preoperatively, 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.

CONCLUSIONS

HRQOL 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.

ABBREVIATIONS BDI-II = Beck Depression Inventory–II; CD = Cushing’s disease; HRQOL = health-related quality of life; MMPI-II = Minnesota Multiphasic Personality Inventory–II; NFPA = nonfunctioning pituitary adenoma; TMT = Trail Making Test.

Supplementary Materials

  • Supplementary Tables 1–5 (PDF 486 KB)
Article Information

Contributor Notes

Correspondence Giovanna Mantovani: Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy. giovanna.mantovani@unimi.it.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.8.JNS19930.

B.Z. and E.V. contributed equally to this study and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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