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van Trigt VR, Pelsma ICM, Biermasz NR. Patient-reported outcomes in refractory hormone-producing pituitary adenomas: an unmet need. Pituitary 2023:10.1007/s11102-023-01309-4. [PMID: 37014498 DOI: 10.1007/s11102-023-01309-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To describe quality and outcomes of patient-reported outcome (PRO) measures (PROMs) used in patients with refractory hormone-producing pituitary adenomas, and to provide an overview of PROs in these challenging pituitary adenomas. METHODS Three databases were searched for studies reporting on refractory pituitary adenomas. For the purpose of this review, refractory adenomas were defined as tumors resistant to primary therapy. General risk of bias was assessed using a component approach and the quality of PROM reporting was assessed using the International Society for Quality of Life Research (ISOQOL) criteria. RESULTS 20 studies reported on PROMs in refractory pituitary adenomas, using 14 different PROMs, of which 4 were disease specific (median general risk of bias score: 33.5% (range 6-50%) and ISOQOL score: 46% (range 29-62%)). SF-36/RAND-36 and AcroQoL were most frequently used. Health-related quality of life in refractory patients (measured by AcroQoL, SF-36/Rand-36, Tuebingen CD-25, and EQ-5D-5L) varied greatly across studies, and was not always impaired compared to patients in remission. CONCLUSION There is a scarcity of data on PROs in the subset of pituitary adenomas that is more difficult to treat, e.g., refractory and these patients are difficult to isolate from the total cohort. The patients' perspective on quality of life, therefore, remains largely unknown in refractory patients. Thus, PROs in refractory pituitary adenomas require adequate analysis using properly reported disease specific PROMs in large cohorts to enable appropriate interpretation for use in clinical practice.
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Affiliation(s)
- Victoria R van Trigt
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Iris C M Pelsma
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors Leiden, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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2
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Joustra GE, ten Dam E, Vermeulen KM, Korsten‐Meijer AGW, Appelman APA, Feijen RA. Prospective evaluation of multidimensional health-related quality of life after endoscopic endonasal surgery for pituitary adenomas using the endoscopic endonasal sinus and skull base surgery questionnaire. Laryngoscope Investig Otolaryngol 2023; 8:7-15. [PMID: 36846430 PMCID: PMC9948581 DOI: 10.1002/lio2.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Social functioning is an important factor in the evaluation of postoperative health-related quality of life (HRQoL) for pituitary adenoma patients. In a prospective cohort study multidimensional HRQoL of non-functioning (NFA) and functioning (FA) pituitary adenoma patients were evaluated following endoscopic endonasal surgery using the endoscopic endonasal sinus and skull base surgery questionnaire (EES-Q). Methods Prospectively, 101 patients were included. The EES-Q was completed preoperatively and postoperatively (2 weeks, 3 months, 1 year). Sinonasal complaints were completed daily during the first week postoperatively. Preoperative and postoperative scores were compared. A generalized estimating equation (uni- and multivariate) analysis was performed to identify significant HRQoL changes related to selected covariates. Results Two weeks postoperatively, physical (p < .05) and social (p < .05) HRQoL are worse and psychological (p < .05) HRQoL improved compared with preoperatively. Three months postoperatively, psychological HRQoL (p = .01) trended back to baseline and no differences in physical or social HRQoL were reported. One year postoperatively, psychological (p = .02) and social (p = .04) HRQoL improved while physical HRQoL remained stable. FA patients report a worse HRQoL preoperatively (social, p < .05) and 3 months postoperatively (social, p < .02 and psychological, p < .02). Sinonasal complaints peak in the first days postoperatively and gradually return to presurgical levels 3 months postoperatively. Conclusions The EES-Q provides meaningful information on multidimensional HRQoL to improve patient-centred health care. Social functioning remains the most difficult area in which to achieve improvements. Despite the relatively modest sample size, there is some indication that the FA group continues to show a downward trend (and thus improvement) even after 3 months, when most other parameters reach stability. Level of evidence Level II-B.
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Affiliation(s)
- Gonneke E. Joustra
- University of Groningen, University Medical Center GroningenDepartment of Otorhinolaryngology ‐ Head and Neck SurgeryGroningenThe Netherlands,Graduate School of Medical Sciences(Groningen University, Institute for Drug Exploration)GroningenThe Netherlands
| | - Ellen ten Dam
- University of Groningen, University Medical Center GroningenDepartment of Otorhinolaryngology ‐ Head and Neck SurgeryGroningenThe Netherlands,Graduate School of Medical Sciences(Groningen University, Institute for Drug Exploration)GroningenThe Netherlands
| | - Karin M. Vermeulen
- Department of EpidemiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Astrid G. W. Korsten‐Meijer
- University of Groningen, University Medical Center GroningenDepartment of Otorhinolaryngology ‐ Head and Neck SurgeryGroningenThe Netherlands
| | - Auke P. A. Appelman
- University of Groningen, University Medical Center GroningenDepartment of RadiologyGroningenThe Netherlands
| | - Robert A. Feijen
- University of Groningen, University Medical Center GroningenDepartment of Otorhinolaryngology ‐ Head and Neck SurgeryGroningenThe Netherlands
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3
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Camerini S, Wennberg A, Adriani M, Martin B, Vettor R, Maffei P, Dassie F. Questionnaire and tools: clinical powerful instrument in acromegaly diagnosis and management. J Endocrinol Invest 2022; 45:1823-1834. [PMID: 35322391 PMCID: PMC9463243 DOI: 10.1007/s40618-022-01782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Acromegaly is a rare chronic disease characterized by systemic comorbidity and reduced quality of life. Although achieving biochemical control has always been the primary goal of acromegaly therapy, recent evidence has shown that the traditional assessment does not adequately capture the complexity of symptoms and patients' perception. These findings result in the need to improve a fast decision-making process of the clinician, who should not only take into account biochemical-instrumental criteria, but also patients' symptoms. With the aim of supporting the clinician in the diagnostic and therapeutic decision-making process several disease-specific tools have been developed. The aim of this review is to provide a description of the acromegaly-specific tools, presenting their main features, their application in daily practice, and their efficacy and utility. METHODS A systematic search of Medline/PubMed, ISI-Web of Knowledge, and Google Scholar databases was done. RESULTS Specific instruments and questionnaires have recently been developed to assist clinicians in the assessment of acromegaly. These are either Patient-Reported Outcome tools, such as Acromegaly Quality of Life Questionnaire (AcroQoL) and Pain Assessment Acromegaly Symptom Questionnaire (PASQ), or Clinician-Reported Outcome tools, such as ACROSCORE, SAGIT® and Acromegaly Disease Activity Tool (ACRODAT®). Such tools are extremely flexible and, therefore, have been widely adopted by endocrinologists and other professionals, so much so that they have also been included as recommendations in the 2018 international guidelines. CONCLUSION Questionnaires and tools are useful in the management of acromegaly patients. They help clinicians evaluate patients' symptoms and could assist in the evaluation of disease activity.
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Affiliation(s)
- S Camerini
- DIMED, University of Padua, Padua, Italy
| | - A Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Adriani
- DIMED, University of Padua, Padua, Italy
| | - B Martin
- DIMED, University of Padua, Padua, Italy
| | - R Vettor
- DIMED, University of Padua, Padua, Italy
| | - P Maffei
- DIMED, University of Padua, Padua, Italy
| | - F Dassie
- DIMED, University of Padua, Padua, Italy.
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4
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Castle-Kirszbaum M, Wang YY, King J, Goldschlager T. Quality of Life After Endoscopic Surgical Management of Pituitary Adenomas. Neurosurgery 2022; 90:81-91. [PMID: 34982874 DOI: 10.1227/neu.0000000000001740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient-reported quality of life (QOL) is a vital metric for surgical success. OBJECTIVE To assess the effect of surgery on QOL in the largest prospectively collected, longitudinal cohort of surgically managed pituitary adenomas. METHODS A consecutive surgical adenoma cohort (n = 304) between late 2016 and mid-2020 underwent a scheduled overall (Anterior Skull Base Questionnaire-35) and sinonasal-specific (Sinonasal Outcome Test-22) QOL assessment. Scores were stratified by adenoma subtype and analyzed for clinical predictors of QOL changes. RESULTS The average age was 53.8 ± 16 yr, and 53% of participants were female. 60.9% of adenomas were nonfunctioning while adrenocorticotropic hormone adenomas (16.4%), growth hormone adenomas (14.1%), and prolactinomas (5.9%) were the most prevalent secreting adenomas. Baseline overall QOL differed between tumor types (P = .006), with adrenocorticotropic hormone adenomas worse than growth hormone adenomas (P = .03) and nonfunctioning pituitary adenomas (NFPA) (P < .001). Sinonasal QOL worsened in the 3 wk after surgery but returned to baseline by 6 wk and beyond. Overall QOL worsened at 3 wk after surgery (P < .001) but significantly improved from baseline by 3 mo (P = .009) and beyond (P < .001). Emotional functioning improved soon after surgery, followed by performance and pain, and then, by 6 mo, physical function and vitality. Predictors of improved QOL were sellar/suprasellar lesions (P = .01), prolactinomas (P = .003), and NFPA (P = .04). Conversely, new postoperative hypopituitarism (P = .04) and larger adenoma volume (P = .04) predicted QOL worsening. CONCLUSION QOL is worsened after surgery at early time points. Prolactinomas and NFPA enjoy significant QOL improvements from surgery as early as 3 mo postoperatively. Other functional tumors may experience early benefits in younger patients without hypopituitarism and when isolated to the sellar/suprasellar region. These findings provide valuable information for counseling patients and setting expectations for surgery.
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Affiliation(s)
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
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5
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Arshad MF, Ogunleye O, Ross R, Debono M. Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study). Pituitary 2021; 24:768-777. [PMID: 33982222 PMCID: PMC8416856 DOI: 10.1007/s11102-021-01153-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. METHODS QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into-Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). RESULTS There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = - 2.5, 95% CI - 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = - 4.9, 95% CI - 10.9 to 1.2; p = 0.12; mental component score MD = - 3.0, 95% CI - 10.5 to 4.4; p = 0.44], or FSS (MD = - 0.004, 95% CI - 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = - 8.3, 95% CI - 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. CONCLUSIONS Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.
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Affiliation(s)
- Muhammad Fahad Arshad
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK.
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
| | - Oluwafunto Ogunleye
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
| | - Richard Ross
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Miguel Debono
- Department of Endocrinology and Diabetes, Sheffield Teaching Hospitals, Glossop Road, Sheffield, S10 2 JF, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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6
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Ballesteros-Herrera D, Briseño-Hernández P, Pérez-Esparza R, Portocarrero-Ortiz LA. Differences in quality of life between genders in acromegaly. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00229. [PMID: 33855226 PMCID: PMC8029512 DOI: 10.1002/edm2.229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 11/09/2022]
Abstract
Objective To study the impact of secondary mental disorders in patients affected with acromegaly and correlate them with quality of life (QoL) and disease status. Design An observational transversal descriptive and comparative study that evaluates QoL's impact due to secondary mental disorders in affected Mexicans with acromegaly using AcroQoL and SF‐36 instruments. Correlation of the results with the disease's biochemical status was performed. According to Beck's scales, anxiety and depression analyses evaluate QoL's impact, and its gender variability is described. Results Eighty‐five patients with diagnoses of acromegaly were included. The mean age was 43.18 years, 47 being women (55.29%). The mean age at diagnosis was 37.95 years, with no difference between men and women. AcroQoL and SF‐36 global and sub‐domain scores differed significantly between men and women, the latter having lower global and individual sub‐domain scores. The mean score of QoL, according to AcroQoL, is 59.40. In women, the mean values are less (55.13) than men (64.68), p = 0.021. The sub‐domain analyses’ scores in physical, appearance and social relationships were less in women (53.21; 47.34; 62.32) than men (62.68; 56.76; 73.87) p = 0.044, 0.069 and 0.013, respectively. Higher Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI) scores correlated with lower QoL as assessed by global and individual sub‐domain scores. Women presented significantly higher BDI and BAI mean scores when compared to men regardless of their biochemical status. Anxiety (p = 0.027) and depression (p < 0.001) severity were higher in women compared to men. Conclusion Correlations between female gender, depression/anxiety scores and QoL require further validation. There is much to be routinely done to improve secondary psychopathology in patients affected by this disease. The need for mental status screening at diagnosis should be emphasized to identify secondary mental illnesses to improve QoL with its treatment.
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Affiliation(s)
| | | | | | - Lesly A Portocarrero-Ortiz
- Universidad Nacional Autónoma de México Mexico City Mexico.,Department of Neuroendocrinology INNN Mexico City Mexico
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7
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Zhang J, Wang Y, Xu X, Gu Y, Huang F, Zhang M. Postoperative complications and quality of life in patients with pituitary adenoma. Gland Surg 2020; 9:1521-1529. [PMID: 33224827 DOI: 10.21037/gs-20-690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Pituitary adenomas (PAs) are tumors that arise from the cells of the anterior pituitary gland. PAs are the most common tumors to occur in the sella area and the third most common intracranial neoplasm in surgery. Due to developments such as microscopy and neuroendoscopy, the curative effect of PA surgery continues to improve. However, postoperative complications may still occur. PA surgery can result in iatrogenic trauma, which is a primary cause of cerebrospinal fluid (CSF) rhinorrhea. PA surgery can affect the posterior pituitary gland, causing decreased antidiuretic hormone secretion and increased urine output, which can lead to hyponatremia. The nasal cavity and sphenoid sinuses may also be damaged during PA surgery, causing the sphenoethmoidal recess to be blocked. This increases the risk of infection. The purpose of this study was to analyze quality of life in PA patients post-resection, and to provide references for the development of early targeted risk assessment programs and intervention measures. Methods We selected patients who underwent neuroendoscopic transnasal PA resection at the Affiliated Hospital of Nantong University between January 2017 and October 2019. These patients' hospital records were retrospectively obtained, including details of any postoperative complications. The patients were followed up by telephone 12 weeks following discharge, and we used the EuroQol 5 Dimensions (EQ-5D) health scale to assess the patients' quality of life. Results At follow-up 3 months after discharge, 68 people (41.72%) had experienced at least one common complication, including 7 cases of infection (4.29%), 56 cases of hypopituitarism (34.36%), 18 cases of CSF rhinorrhea (11.04%), 28 cases of diabetes insipidus (17.18%), and 25 cases of hyponatremia (15.34%). Patients that experienced complications reported having more serious problems on the dimensions of the EQ-5D descriptive system (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) than patients without complications. The scores of patients with complications on the EQ-5D visual analog scale (EQ-VAS) were lower than that of patients without complications. Conclusions Postoperative complications are negatively associated with quality of life in PA patients. Actively preventing common complications could therefore improve these patients' quality of life and reduce their burden of disease.
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Affiliation(s)
- Jiajia Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ya Wang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiuqun Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, China
| | - Yudan Gu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Fei Huang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Min Zhang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, China
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8
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Wild CM, Stieg M, Stalla GK, Auer MK, Athanasoulia-Kaspar AP. Health-related quality of life in patients with non-functioning pituitary adenoma: a special focus on hydrocortisone replacement dose. Qual Life Res 2020; 29:3325-3331. [PMID: 32737686 DOI: 10.1007/s11136-020-02582-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with non-functioning pituitary adenomas (NFPA) suffer from pronounced impairments in physical and mental measures that result in an impairment of health-related quality of life (HRQOL). The role of secondary adrenal insufficiency (SAI) and especially the one of the hydrocortisone (HC) replacement dose on the HRQOL seems to be conflicting. The primary aim of this study is to assess the HRQOL in patients with NFPA in terms of presence of SAI and in patients without SAI and the secondary to explore the impact of treatment parameters such as daily HC dose. DESIGN/METHODS In a cross-sectional study we evaluated parameters of HRQOL in 95 patients with NFPA of the Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry in Munich using standardized questionnaires like Short Form (SF-36), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and a self-constructed questionnaire about medical history. RESULTS We could not find any significant difference between patients with and without SAI in the standardized questionnaires in terms of HRQOL. We could show that higher doses of HC were negatively correlated with HRQOL measured by SF-36 global health score regardless of using BDI or STAI in the block (β = - 0.397; p = 0.021, β = - 0.390; p = 0.016, respectively). CONCLUSIONS NFPA patients with SAI do not have a worse HRQOL than patients with NFPA and intact corticotropic axis. We could show that higher doses of HC are associated with an impaired HRQOL measured by SF-36 global and physical health score, whereas mental health score is not significantly influenced by the HC dose.
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Affiliation(s)
- Carl Mathis Wild
- Gynecology and Obstetrics, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Mareike Stieg
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Günter K Stalla
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany.,Medicover Neuroendocrinology, Orleansplatz 3, 81667, Munich, Germany
| | - Matthias K Auer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany
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9
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Zarino B, Verrua E, Ferrante E, Sala E, Carosi G, Giavoli C, Serban AL, Del Sindaco G, Sirtori MA, Bertani GA, Rampini P, Carrabba GG, Arosio M, Spada A, Locatelli M, Mantovani G. Cushing's disease: a prospective case-control study of health-related quality of life and cognitive status before and after surgery. J Neurosurg 2019; 133:1721-1731. [PMID: 31731265 DOI: 10.3171/2019.8.jns19930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
| | - Elisa Verrua
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Emanuele Ferrante
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Elisa Sala
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Giulia Carosi
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Claudia Giavoli
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Andreea L Serban
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- 6Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Giulia Del Sindaco
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Martina A Sirtori
- 1Neurosurgery Unit and
- 5Department of Psychology, University of Milano-Bicocca, Milan; and
| | | | | | | | - Maura Arosio
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
| | - Anna Spada
- Departments of3Clinical Sciences and Community Health, and
| | - Marco Locatelli
- 1Neurosurgery Unit and
- 4Pathophysiology and Transplantation, University of Milan
| | - Giovanna Mantovani
- 2Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Departments of3Clinical Sciences and Community Health, and
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10
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Sommerfelt H, Sagberg LM, Solheim O. Impact of transsphenoidal surgery for pituitary adenomas on overall health-related quality of life: a longitudinal cohort study. Br J Neurosurg 2019; 33:635-640. [PMID: 31544528 DOI: 10.1080/02688697.2019.1667480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Previous studies show a moderate improvement in health-related quality of life (HRQoL) following transsphenoidal surgery for pituitary adenomas, but no consistent predictors of HRQoL outcome have been identified. We aimed to evaluate overall HRQoL changes following such surgery, and assess potential patient or tumour characteristics that predict HRQoL outcome.Materials and methods: Sixty adult patients undergoing transsphenoidal resection of pituitary adenomas were prospectively enrolled. They completed the EQ-5D 3L, a generic HRQoL questionnaire, preoperatively, and at one (n = 57) and six months (n = 56) postoperatively. HRQoL was assessed as both postoperative change in median EQ-5D 3L score, and as change greater than the minimal clinically important difference (MCID) in EQ-5D 3L score. A multivariable logistic regression analysis was performed to assess potential predictors of clinically significant HRQoL changes (>MCID) at six months postoperatively.Results: There was a slight, but statistically significant, improvement in median EQ-5D 3L scores at six months postoperatively compared to preoperatively. Sixteen patients (29%) reported a clinically significant improvement in HRQoL at six months postoperatively, and larger preoperative tumour volume was a statistically significant predictor of such improvement. Eight patients (14%) reported a clinically significant deterioration in HRQoL at six months, but none of the assessed variables predicted such deterioration.Conclusions: Patient-reported overall HRQoL improved slightly after transsphenoidal surgery for pituitary adenomas at group level. Patients with larger tumours might have more HRQoL benefits from surgery, but the mechanisms behind the predictive nature of tumour volume remain unknown.
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Affiliation(s)
- Hanne Sommerfelt
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lisa Millgård Sagberg
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olav´s University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olav´s University Hospital, Trondheim, Norway
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurosurgery, St. Olav´s University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olav´s University Hospital, Trondheim, Norway
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11
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Pertichetti M, Serioli S, Belotti F, Mattavelli D, Schreiber A, Cappelli C, Padovani A, Gasparotti R, Nicolai P, Fontanella MM, Doglietto F. Pituitary adenomas and neuropsychological status: a systematic literature review. Neurosurg Rev 2019; 43:1065-1078. [DOI: 10.1007/s10143-019-01134-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 06/10/2019] [Indexed: 12/16/2022]
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12
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Kunzler LS, Naves LA, Casulari LA. The Effect of Cognitive-Behavioral Therapy on Acromegalics After a 9-Month Follow-Up. Front Endocrinol (Lausanne) 2019; 10:380. [PMID: 31244782 PMCID: PMC6581695 DOI: 10.3389/fendo.2019.00380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The quality of life of acromegalics is compromised. Treatment with the "Think healthy and feel the difference" technique has been described as effective in the improvement of the quality of life of these patients in the short term. However, its effectiveness in the long term needs to be evaluated. Objective: The purpose of this study was to evaluate whether the good results obtained from the "Think healthy and feel the difference" technique in the short term persists in the long term, after the end of the treatment. Method: This is a non-randomized longitudinal study with 23 acromegalic divided into two groups: an intervention group with 10 patients and a control group with 13 patients. The intervention itself covered nine group sessions, organized weekly, using a technique called "Think healthy and feel the difference." The control group did not receive the aforementioned treatment. The Short Form 36 Question Health Survey (SF-36) and the Beck Depression Inventory were administered before the sessions began, at the end of the nine therapy sessions and at the 9-month follow-up. Results: At the end of the treatment, the results of the SF-36 showed improvement in the mental health of the intervention group compared to the control group. The effects of therapy were maintained at the 9 month follow-up. Conclusion: Cognitive-behavioral therapy, applied in a group format, can improve the quality of life of acromegalic patients in the short- and long-term.
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Affiliation(s)
| | - Luciana Ansaneli Naves
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Luiz Augusto Casulari
- Endocrinology Service of the Brasilia University Hospital, Brasilia, Brazil
- Clinic of Neurology and Endocrinology, Brasilia, Brazil
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13
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Gadelha MR, Kasuki L, Lim DST, Fleseriu M. Systemic Complications of Acromegaly and the Impact of the Current Treatment Landscape: An Update. Endocr Rev 2019; 40:268-332. [PMID: 30184064 DOI: 10.1210/er.2018-00115] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
Abstract
Acromegaly is a chronic systemic disease with many complications and is associated with increased mortality when not adequately treated. Substantial advances in acromegaly treatment, as well as in the treatment of many of its complications, mainly diabetes mellitus, heart failure, and arterial hypertension, were achieved in the last decades. These developments allowed change in both prevalence and severity of some acromegaly complications and furthermore resulted in a reduction of mortality. Currently, mortality seems to be similar to the general population in adequately treated patients with acromegaly. In this review, we update the knowledge in complications of acromegaly and detail the effects of different acromegaly treatment options on these complications. Incidence of mortality, its correlation with GH (cumulative exposure vs last value), and IGF-I levels and the shift in the main cause of mortality in patients with acromegaly are also addressed.
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Affiliation(s)
- Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.,Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Dawn S T Lim
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Maria Fleseriu
- Department of Endocrinology, Diabetes and Metabolism, Oregon Health and Science University, Portland, Oregon.,Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon.,Northwest Pituitary Center, Oregon Health and Science University, Portland, Oregon
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14
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Ishikawa T, Takeuchi K, Nagatani T, Aimi Y, Tanemura E, Tambara M, Nagata Y, Choo J, Wakabayashi T. Quality of Life Changes Before and After Transsphenoidal Surgery for Sellar and Parasellar Lesions. World Neurosurg 2018; 122:e1202-e1210. [PMID: 30447458 DOI: 10.1016/j.wneu.2018.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although reports regarding the relationship between surgical complications and quality of life (QOL) exist, a general consensus regarding this issue is lacking. The aim of this study was to evaluate QOL after endoscopic transsphenoidal approach. METHODS We assessed patients with sellar or parasellar lesions that were removed with endoscopic transsphenoidal approach or extended endoscopic transsphenoidal approach between January 2010 and December 2016. 36-Item Short Form Health Survey and 30-Item General Health Questionnaire QOL scores were obtained preoperatively and 1 month and 6 months postoperatively. RESULTS We analyzed 89 patients with nonfunctioning pituitary adenoma (NFPA) and 39 patients with acromegaly. Physical QOL decreased 1 month after surgery but recovered after 6 months in both groups. Mental QOL improved postoperatively compared with preoperatively. Patients with acromegaly had a worse Physical Component Summary (PCS) on 36-Item Short Form Health Survey (48.7, 28.9, and 41.0) at 6 months than patients with NFPA. The low preoperative PCS group did not improve until 6 months postoperatively. Multiple regression analysis revealed the following factors were key to postoperative QOL: age (NFPA PCS 6 months postoperatively; correlation coefficient = -0.489), preoperative Mental Component Summary (MCS) (NFPA MCS 6 months postoperatively, correlation coefficient = 0.573), body mass index (acromegaly PCS 6 months postoperatively; correlation coefficient = -0.376), preoperative PCS (acromegaly PCS 6 months postoperatively; correlation coefficient = 0.905), and preoperative MCS (acromegaly MCS 6 months postoperatively; correlation coefficient = 0.726). CONCLUSIONS Endoscopic transsphenoidal approach can improve QOL in patients by 6 months postoperatively. In patients with acromegaly with significant QOL impairments preoperatively, surgery sometimes may be unable to normalize QOL.
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Affiliation(s)
- Takayuki Ishikawa
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yuri Aimi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Eriko Tanemura
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Chuno Kosei Hospital, Seki, Gifu, Japan
| | - Masao Tambara
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Okazaki City Hospital, Okazaki, Aichi, Japan
| | - Yuichi Nagata
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Jungsu Choo
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Chukyo Hospital, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
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15
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Abstract
BACKGROUND The delayed diagnosis, altered body image, and clinical complications associated with acromegaly impair quality of life. PURPOSE To assess the efficacy of the cognitive-behavioral therapy (CBT) technique "Think Healthy" to increase the quality of life of patients with acromegaly. METHODS This non-randomized clinical trial examined ten patients with acromegaly (nine women and one man; mean age, 55.5 ± 8.4 years) from a convenience sample who received CBT. The intervention included nine weekly group therapy sessions. The quality of life questionnaire the 36-Item Short Form Survey (SF-36) and the Beck Depression Inventory (BDI) were administered during the pre- and post-intervention phases. The Wilcoxon signed-rank test was performed to assess the occurrence of significant differences. RESULTS According to the SF-36, the general health domain significantly improved (d' = - 0.264; p = 0.031). The mental health domain improved considerably (d' = - 1.123; p = 0.012). Physical functioning showed a non-significant trend toward improvement (d' = - 0.802; p = 0.078), although four of the five patients who showed floor effects improved and remained at this level. Regarding emotional well-being, five patients showed floor effects and four improved, and the condition did not change among any of the four patients who showed ceiling effects. No significant changes were found with regard to the other domains. No significant differences in the BDI were found before or after the intervention. CONCLUSION The technique presented herein effectively improved the quality of life of patients with acromegaly with different levels of disease activity, type, and treatment time.
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Affiliation(s)
- Lia Silvia Kunzler
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil.
| | - Luciana Ansaneli Naves
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
| | - Luiz Augusto Casulari
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
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16
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Andela CD, Lobatto DJ, Pereira AM, van Furth WR, Biermasz NR. How non-functioning pituitary adenomas can affect health-related quality of life: a conceptual model and literature review. Pituitary 2018; 21:208-216. [PMID: 29302835 PMCID: PMC5849670 DOI: 10.1007/s11102-017-0860-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
After treatment for a non-functioning pituitary adenoma (NFA) health-related quality of life (HR-QoL) improves considerably. However, the literature about the normalization of HR-QoL after treatment is inconclusive. Some researchers described a persistently decreased HR-QoL compared to reference data, while others did not. Considering this variety in observed HR-QoL outcomes, the aim of the present review was to provide a literature overview of health outcomes in patients with a NFA, using a conceptual HR-QoL model. A concrete conceptualization of the health outcomes of patients with a NFA can be helpful to understand the observed variety in HR-QoL outcomes and to improve clinical care and guidance of these patients. For this conceptualization, the Wilson and Cleary model was used. This model has a biopsychosocial character and has been validated in several patient populations. In the present review, health outcomes of patients with a NFA were described at each stage of the model e.g. biological and physiological variables, symptom status, functional status, general health perceptions and overall HR-QoL. The Wilson-Cleary model elucidates that elements at each stage of the model can contribute to the impairment in HR-QoL of patients with a NFA, which explains the reported variety in the literature. Furthermore, by applying the model, potential interventions targeting these elements can be identified. While optimal biomedical treatment has always been the focus, it is clearly not sufficient for good HR-QoL in patients with a NFA. Further improvement of HR-QoL should be supported by a pituitary specific care trajectory, including psychosocial care (e.g. self-management training), to beneficially affect characteristics of the patient and the (healthcare) environment, with the utmost goal to optimize HR-QoL in patients after treatment.
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Affiliation(s)
- Cornelie D Andela
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Center for Endocrine Tumors, C7-Q, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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17
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Fujio S, Arimura H, Hirano H, Habu M, Bohara M, Moinuddin FM, Kinoshita Y, Arita K. Changes in quality of life in patients with acromegaly after surgical remission - A prospective study using SF-36 questionnaire. Endocr J 2017; 64:27-38. [PMID: 27681883 DOI: 10.1507/endocrj.ej16-0182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Patients with acromegaly have a compromised quality of life (QOL). Modern surgical techniques have improved the surgical cure rate. However, there are no prospective studies reporting postoperative changes in QOL among patients cured solely by surgery. The aim of the present study was to determine the effect of surgery on QOL using the 36-item short form health survey (SF-36) questionnaire. SF-36 scores comprise 3 components: the physical component summary (PCS), the mental component summary (MCS) and role-social component summary (RCS). Included in this prospective cohort were 41 patients with acromegaly who underwent surgery alone and achieved postoperative normalization of insulin-like growth factor-1. All participants completed the SF-36 preoperatively and 1 year postoperatively. Preoperatively, RCS and 4 subscale scores (role physical, social functioning, role emotional, mental health) were below the set standards for the normal population. Postoperatively, the PCS and RCS scores did not change significantly, but the MCS score improved significantly (from 48.1 ± 11.3 to 51.7 ± 8.9, p=0.03). Further we compared the QOL of 26 patients whose nadir GH level was < 0.4 μg/L during postoperative oral glucose tolerance testing (complete remission group) with that of 15 patients whose nadir GH level was ≥ 0.4 μg/L (partial remission group). There were no significant differences between these groups in terms of PCS, MCS, RCS, or any subscale scores. In conclusion, surgical remission mostly improved the participants' mental condition. There was no difference in QOL between patients who achieved the new remission criteria and those who did not.
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Affiliation(s)
- Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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18
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Geraedts VJ, Andela CD, Stalla GK, Pereira AM, van Furth WR, Sievers C, Biermasz NR. Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters. Front Endocrinol (Lausanne) 2017; 8:40. [PMID: 28316591 PMCID: PMC5334635 DOI: 10.3389/fendo.2017.00040] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/16/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Quality of life (QoL) in patients with acromegaly is reduced irrespective of disease state. The contributions of multifactorial determinants of QoL in several disease stages are presently not well known. OBJECTIVE To systematically review predictors of QoL in acromegalic patients. METHODS Main databases were systematically searched using predefined search terms for potentially relevant articles up to January 2017. Inclusion criteria included separate acromegaly cohort, non-hereditary acromegaly, QoL as study parameter with clearly described method of measurement and quantitative results, N ≥ 10 patients, article in English and adult patients only. Data extraction was performed by two independent reviewers; studies were included using the PRISMA flow diagram. RESULTS We identified 1,162 studies; 51 studies met the inclusion criteria: 31 cross-sectional observational studies [mean AcroQoL score 62.7 (range 46.6-87.0, n = 1,597)], 9 had a longitudinal component [mean baseline AcroQoL score 61.4 (range 54.3-69.0, n = 386)], and 15 were intervention studies [mean baseline AcroQoL score 58.6 (range 52.2-75.3, n = 521)]. Disease-activity reflected by biochemical control measures yielded mixed, and therefore inconclusive results with respect to their effect on QoL. Addition of pegvisomant to somatostatin analogs and start of lanreotide autogel resulted in improvement in QoL. Data from intervention studies on other treatment modalities were too limited to draw conclusions on the effects of these modalities on QoL. Interestingly, higher BMI and greater degree of depression showed consistently negative associations with QoL. Hypopituitarism was not significantly correlated with QoL in acromegaly. CONCLUSION At present, there is insufficient published data to support that biochemical control, or treatment of acromegaly in general, is associated with improved QoL. Studies with somatostatin receptor ligand treatment, i.e., particularly lanreotide autogel and pegvisomant have shown improved QoL, but consensus on the correlation with biochemical control is missing. Longitudinal studies investigating predictors in treatment-naive patients and their follow-up after therapeutic interventions are lacking but are urgently needed. Other factors, i.e., depression and obesity were identified from cross-sectional cohort studies as consistent factors associated with poor QoL. Perhaps treatment strategies of acromegaly patients should not only focus on normalizing biochemical markers but emphasize improvement of QoL by alternative interventions such as psychosocial or weight lowering interventions.
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Affiliation(s)
- Victor J. Geraedts
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Cornelie D. Andela
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Günter K. Stalla
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
| | - Alberto M. Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Wouter R. van Furth
- Department of Medicine, Division of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Caroline Sievers
- Department of Clinical Neuroendocrinology, Max Planck Institut für Psychiatrie, Munich, Germany
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Nienke R. Biermasz,
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19
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Caron PJ, Bevan JS, Petersenn S, Houchard A, Sert C, Webb SM. Effects of lanreotide Autogel primary therapy on symptoms and quality-of-life in acromegaly: data from the PRIMARYS study. Pituitary 2016; 19:149-57. [PMID: 26603536 PMCID: PMC4799252 DOI: 10.1007/s11102-015-0693-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the effects of lanreotide Autogel on patient-reported outcomes and association with biochemical control, using PRIMARYS data. METHODS PRIMARYS was a 1-year, open-label study of lanreotide Autogel (Depot in USA) 120 mg every 4 weeks in 90 treatment-naïve patients with acromegaly. Symptoms were assessed using Patient-assessed Acromegaly Symptom Questionnaire (PASQ) and health-related quality of life (HRQoL) using the AcroQoL questionnaire. Correlations between PASQ and AcroQoL scores, and between PASQ/AcroQoL and growth hormone (GH)/insulin-like growth factor-1 (IGF-1) levels were also evaluated (post hoc). RESULTS Acromegaly symptoms and HRQoL significantly improved from week 12 to week 48, with modest correlations at week 48 between PASQ total score (R = -0.55, p < 0.0001) and AcroQoL global and physical scores (R = -0.67, p < 0.0001). Approximately 60% of patients achieved a minimal important difference (MID; improvement >50% of baseline standard deviation) in PASQ total score and >40% achieved a MID in AcroQoL global score (post hoc). Changes in PASQ scores were similar in biochemically controlled (GH levels ≤2.5 μg/L and normal IGF-1 levels) and uncontrolled groups, while changes in global and psychological AcroQoL scores were greater in the controlled group. There was no correlation between changes in PASQ or AcroQoL scores and changes in GH or IGF-1 levels. CONCLUSIONS Primary treatment with lanreotide Autogel over 1 year was associated with rapid and sustained improvements in clinical signs and symptoms and HRQoL in patients with acromegaly. Improvements in HRQoL, but not symptoms, were greater in those achieving biochemical control (ClinicalTrials.gov: NCT00690898; EudraCT: 2007-000155-34).
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Affiliation(s)
- Philippe J Caron
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Universitaire Larrey, Toulouse, France.
| | - John S Bevan
- Department of Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | | | | | - Susan M Webb
- Departments of Endocrinology/Medicine, Sant Pau Biomedical Research Institute, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER Unit 747), ISCIII, Barcelona, Spain
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20
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Burkhardt T, Lüdecke D, Spies L, Wittmann L, Westphal M, Flitsch J. Hippocampal and cerebellar atrophy in patients with Cushing’s disease. Neurosurg Focus 2015; 39:E5. [DOI: 10.3171/2015.8.focus15324] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Cushing’s disease (CD) may cause atrophy of different regions of the human brain, mostly affecting the hippocampus and the cerebellum. This study evaluates the use of 3-T MRI of newly diagnosed patients with CD to detect atrophic degeneration with voxel-based volumetry.
METHODS
Subjects with newly diagnosed, untreated CD were included and underwent 3-T MRI. Images were analyzed using a voxelwise statistical test to detect reduction of brain parenchyma. In addition, an atlas-based volumetric study for regions likely to be affected by CD was performed.
RESULTS
Nineteen patients with a mean disease duration of 24 months were included. Tumor markers included adre-nocorticotropic hormone (median 17.5 pmol/L), cortisol (949.4 nmol/L), and dehydroepiandrosterone sulfate (5.4 μmol/L). The following values are expressed as the mean ± SD. The voxelwise statistical test revealed clusters of significantly reduced gray matter in the hippocampus and cerebellum, with volumes of 2.90 ± 0.26 ml (right hippocampus), 2.89 ± 0.28 ml (left hippocampus), 41.95 ± 4.67 ml (right cerebellar hemisphere), and 42.11 ± 4.59 ml (left cerebellar hemisphere). Healthy control volunteers showed volumes of 3.22 ± 0.25 ml for the right hippocampus, 3.23 ± 0.25 ml for the left hippocampus, 50.87 ± 4.23 ml for the right cerebellar hemisphere, and 50.42 ± 3.97 ml for the left cerebellar hemisphere.
CONCLUSIONS
Patients with untreated CD show significant reduction of gray matter in the cerebellum and hippocampus. These changes can be analyzed and objectified with the quantitative voxel-based method described in this study.
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Affiliation(s)
| | - Daniel Lüdecke
- 2Psychiatry, University Medical Center Hamburg-Eppendorf; and
| | | | - Linus Wittmann
- 2Psychiatry, University Medical Center Hamburg-Eppendorf; and
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21
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Andela CD, Scharloo M, Pereira AM, Kaptein AA, Biermasz NR. Quality of life (QoL) impairments in patients with a pituitary adenoma: a systematic review of QoL studies. Pituitary 2015; 18:752-76. [PMID: 25605584 DOI: 10.1007/s11102-015-0636-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Pituitary adenomas give rise to physical and psychological symptoms, which may persist after biochemical cure. Growing attention has been paid to quality of life (QoL) in these patients. We aimed to systematically analyze QoL assessment methods and QoL outcome in these patients. METHODS We conducted a systematic literature search up to January 2014 in PubMed, Web of Knowledge, PsycInfo and EMBASE. RESULTS 102 papers assessing QoL in patients with a pituitary adenoma were included. In clinical (original) studies in which QoL was the primary outcome parameter (n = 54), 19 studies combined a generic questionnaire with a disease-specific questionnaire. QoL was found to be impaired in patients with active disease relative to controls, and generally improved during biochemical cure. However, no normalization occurred, with patients with remitted Cushing's disease demonstrating the smallest improvement. Somatic factors (e.g., hypopituitarism, sleep characteristics), psychological factors (illness perceptions) and health care environment (rural vs. urban) were identified as influencing factors. Intervention studies (predominantly evaluating medical interventions) have been found to improve QoL. CONCLUSIONS The growing number of studies assessing QoL generally described the negative impact of pituitary adenomas. QoL research in this patient group could be further elaborated by the development of disease-specific questionnaires for prolactinoma and non-functioning adenoma, consequent use of generic and disease-specific questionnaires and using a long-term (longitudinal) follow-up. Surgical and pharmacological interventions improve but not normalize QoL. We postulate that there might be margin for further improvement of QoL, for instance by using psychosocial interventions, in addition to optimal medical treatment.
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Affiliation(s)
- Cornelie D Andela
- Division of Endocrinology and Center for Endocrine Tumors Leiden, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands,
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Milian M, Honegger J, Teufel P, Wolf A, Psaras T. Tuebingen CD-25 is a sensitive tool to investigate health-related quality of life in Cushing's disease patients in the course of the disease. Neuroendocrinology 2013; 98:188-99. [PMID: 24080783 DOI: 10.1159/000355622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The primary object was to investigate whether the Tuebingen CD-25 captures changes in health-related quality of life (HRQoL) sensitively in Cushing's disease (CD) and to identify factors that favour postoperative HRQoL. METHODS 17 CD patients were scheduled for transsphenoidal tumour removal and filled out the inventory before and after surgery. The mean time elapsed after surgery was 14.4 ± 11.3 months. All patients were in remission at the second timepoint of investigation. RESULTS HRQoL as assessed with the Tuebingen CD-25 improved significantly after successful surgical tumour removal. A large effect size (Cohen's d = 0.84) in the total score indicates good sensitivity to change. 13 patients (76.5%) showed impaired HRQoL preoperatively compared with a general population sample. Postoperatively, 35.3% of the patients still suffered from an impaired HRQoL. Stepwise linear regression analysis revealed that less comorbidities (≤2) and greater morning cortisol decrease were promotive factors for better postoperative HRQoL (p < 0.05). The postoperative improvement in HRQoL could be best predicted by the presence of preoperative HRQoL impairment and age of the patients, i.e. patients who were younger were more likely to improve. Moreover, patients without postoperative pituitary deficiencies improved significantly more in the cognition scale. A tendency towards more improvement in overall HRQoL was observed in non-hypocortisolaemic patients. CONCLUSIONS The Tuebingen CD-25 has proved to be a capable and sensitive instrument to investigate HRQoL in the course of disease. The number of postoperative comorbidities had the greatest impact on postoperative well-being.
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Affiliation(s)
- Monika Milian
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
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