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Lyu X, Zhang D, Pan H, Zhu H, Chen S, Lu L. A noninvasive scoring model for the differential diagnosis of ACTH-dependent Cushing's syndrome: a retrospective analysis of 311 patients based on easy-to-use parameters. Endocrine 2022; 78:114-122. [PMID: 35925471 DOI: 10.1007/s12020-022-03081-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The differential diagnosis of ACTH-dependent Cushing's disease (CS) is challenging. The gold standard approach bilateral inferior petrosal sinus sampling (BIPSS) is expensive and invasive, while other noninvasive tests, like the high-dose dexamethasone suppression test (HDDST), provide unsatisfactory diagnostic accuracy. This study aimed to find a new noninvasive practical approach with higher diagnostic accuracy to differently diagnose ACTH-dependent CS, which can be used in centers where BIPSS cannot be applied. METHODS 264 Cushing's disease (CD) patients and 47 ectopic ACTH secretion syndrome (EAS) patients were analyzed in this single-center retrospective study (2011-2021). The multivariate logistic model was used to construct the scoring model. RESULTS Female (adjusted OR 3.030, 95%CI 1.229-7.471), hypokalemia (0.209, 0.076-0.576), ACTH (0.988, 0.982-0.994), MRI pituitary lesion positive (8.671, 3.521-21.352), and HDDST positive (2.768, 1.139-6.726) have a strong association with the differential diagnosis of ACTH-dependent CS and were included in the final multivariable logistic regression model. A -14-to-14-point noninvasive scoring model was built on the model. The AUC of the noninvasive scoring model was 0.915 (95% CI 0.869-0.960), significantly higher than the AUC of HDDST (0.756, 95% CI 0.685-0.825, P = 0.004). The optimal cutoff of the model was ≥0 to diagnose CD. The sensitivity of the noninvasive scoring model was 91.3% (95% CI 87.3%-94.1%), and the specificity was 80.9% (95% CI 67.5%-89.6%). When the model's sensitivity was 100.0%, the cutoff was ≥ -10 with a specificity of 19.2%; when the model's specificity was 100.0%, the cutoff was ≥ 13 with a sensitivity of 22.7%. CONCLUSIONS We developed a noninvasive scoring model to distinguish CD and EAS in ACTH-dependent CS patients with higher diagnostic utility than HDDST in the same cohort. The noninvasive scoring model might be applied in areas where BIPSS is unavailable, the CRH is hard to obtain, or the desmopressin stimulation is not widely applied. It also provided a triage tool for selecting patients that might benefit the most from a further BIPSS test.
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Affiliation(s)
- Xiaohong Lyu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
- Eight-year Program of Clinical Medicine, Peking Union Medical College, 100730, Beijing, China
| | - Dingyue Zhang
- Eight-year Program of Clinical Medicine, Peking Union Medical College, 100730, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China.
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 100730, Beijing, China.
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Šojat AS, Dunjić-Kostić B, Marina LV, Ivović M, Radonjić NV, Kendereški A, Ćirković A, Tančić-Gajić M, Arizanović Z, Mihajlović S, Vujović S. Depression: another cortisol-related comorbidity in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion. J Endocrinol Invest 2021; 44:1935-1945. [PMID: 33528757 DOI: 10.1007/s40618-021-01509-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Hypercortisolism is associated with a high prevalence of depression and impaired health-related quality of life (QoL). According to the available literature, studies examining the depression risk in patients with adrenal incidentalomas (AI), nonfunctioning and the ones with (possible) autonomous cortisol secretion ((P)ACS) are scarce. The aim of this observational, case-control study was to screen patients with nonfunctioning adrenal incidentalomas (NAI) and the ones with (P)ACS for depression and to assess their QoL. METHODS The total studied group consisted of 92 subjects-26 with NAI, 34 with (P)ACS and 32 age-matched healthy controls (HC). To screen for depression, we used the Beck Depression Inventory-II (BDI-II) and to assess the QoL, we used the Short-Form 36 Health Survey (SF-36). RESULTS Patients with (P)ACS had significantly higher BDI-II scores and substantially lower QoL than patients with NAI or HC. Midnight cortisol level was the most significant predictor of BDI-II and SF-36 score. The receiver operating characteristic curve analysis demonstrated that a midnight cortisol value of 86.95 nmol/l had a high sensitivity (82.8%) and high specificity (80%) for detection of mild depression in patients with (P)ACS. CONCLUSION Screening for depression and QoL assessment should become an integral part of clinical evaluation in patients with (P)ACS.
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Affiliation(s)
- A S Šojat
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - B Dunjić-Kostić
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Clinic for Psychiatry, Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - L V Marina
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
| | - M Ivović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - N V Radonjić
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - A Kendereški
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - A Ćirković
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Institute of Medical Statistics and Informatics, Dr Subotica 15, 11000, Belgrade, Serbia
| | - M Tančić-Gajić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Z Arizanović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
| | - S Mihajlović
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- University Hospital Centre Dr Dragisa Misovic, Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - S Vujović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Dr Subotica 13, 11000, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
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Frara S, Allora A, di Filippo L, Formenti AM, Loli P, Polizzi E, Tradati D, Ulivieri FM, Giustina A. Osteopathy in mild adrenal Cushing's syndrome and Cushing disease. Best Pract Res Clin Endocrinol Metab 2021; 35:101515. [PMID: 33795196 DOI: 10.1016/j.beem.2021.101515] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathophysiology and effects of endogenous glucocorticoid (GC) excess on skeletal endpoints as well as awareness and management of bone fragility are reviewed. Cushing's syndrome (CS) increase the risk of fracture affecting prevalently bone quality. Bone antiresorptive agents (SERMs, bisphosphonates and denosumab) as well as teriparatide increase bone mineral density and in some instances reduce fracture risk. Awareness and management of bone health in CS can be improved.
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Affiliation(s)
- Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Loli
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Daniele Tradati
- Department of Orthopedics and Traumatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Massimo Ulivieri
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
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Ehrlich K, Morbach C, Reiter T, Heuschmann PU, Hannemann A, Fassnacht M, Störk S, Hahner S, Deutschbein T. Rationale and design of the cardiovascular status in patients with endogenous cortisol excess study (CV-CORT-EX): a prospective non-interventional follow-up study. BMC Endocr Disord 2021; 21:11. [PMID: 33419423 PMCID: PMC7791745 DOI: 10.1186/s12902-020-00665-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Endogenous Cushing's syndrome (CS) results in increased cardiovascular (CV) morbidity and mortality. So far, most studies focussed on distinct disease entities rather than the integrity of the CV system. We here describe the design of the Cardiovascular Status in Endogenous Cortisol Excess Study (CV-CORT-EX), a study aiming to comprehensively investigate the health status of patients with endogenous CS (with a particular focus on CV phenotypes, biochemical aspects, quality of life, and psychosocial status). METHOD A prospective non-interventional cohort study performed at a German tertiary referral centre. At the time of enrolment, patients will be categorised as: (1) newly diagnosed overt CS, (2) recurrent overt CS, (3) CS in remission, (4) presence of mild autonomous cortisol excess (MACE). The target cohorts will be n = 40 (groups 1 + 2), n = 80 (group 3), and n = 20 (group 4). Patients with overt CS at the time of enrolment will be followed for 12 months after remission (with re-evaluations after 6 and 12 months). At each visit, patients will undergo transthoracic echocardiography, cardiac magnetic resonance imaging, 24-h electrocardiogram, 24-h blood pressure measurement, and indirect evaluation of endothelial function. Furthermore, a standardised clinical investigation, an extensive biochemical workup, and a detailed assessment of quality of life and psychosocial status will be applied. Study results (e.g. cardiac morphology and function according to transthoracic echocardiography and cardiac magnetic resonance imaging; e.g. prevalence of CV risk factors) from patients with CS will be compared with matched controls without CS derived from two German population-based studies. DISCUSSION CV-CORT-EX is designed to provide a comprehensive overview of the health status of patients with endogenous CS, mainly focussing on CV aspects, and the holistic changes following remission. TRAIL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ) NCT03880513, registration date: 19 March 2019 (retrospectively registered). Protocol Date: 28 March 2014, Version 2.
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Affiliation(s)
- Kristina Ehrlich
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Caroline Morbach
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Academic Core Lab Ultrasound-based Cardiovascular Imaging, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Theresa Reiter
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Peter Ulrich Heuschmann
- Clinical Trial Centre, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, Division of Cardiology, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Stefanie Hahner
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, University of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
- Medicover Oldenburg MVZ, Oldenburg, Germany.
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van der Meulen M, Zamanipoor Najafabadi AH, Lobatto DJ, Andela CD, Vliet Vlieland TPM, Pereira AM, van Furth WR, Biermasz NR. SF-12 or SF-36 in pituitary disease? Toward concise and comprehensive patient-reported outcomes measurements. Endocrine 2020; 70:123-133. [PMID: 32562182 PMCID: PMC7525280 DOI: 10.1007/s12020-020-02384-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Pituitary diseases severely affect patients' health-related quality of life (HRQoL). The most frequently used generic HRQoL questionnaire is the Short Form-36 (SF-36). The shorter 12-item version (SF-12) can improve efficiency of patient monitoring. This study aimed to determine whether SF-12 can replace SF-36 in pituitary care. METHODS In a longitudinal cohort study (August 2016 to December 2018) among 103 endoscopically operated adult pituitary tumor patients, physical and mental component scores (PCS and MCS) of SF-36 and SF-12 were measured preoperatively, and 6 weeks and 6 months postoperatively. Chronic care was assessed with a cross-sectional study (N = 431). Mean differences and agreement between SF-36 and SF-12 change in scores (preoperative vs. 6 months) were assessed with intraclass correlation coefficients (ICC) and limits of agreement, depicting 95% of individual patients. RESULTS In the longitudinal study, mean differences between change in SF-36 and SF-12 scores were 1.4 (PCS) and 0.4 (MCS) with fair agreement for PCS (ICC = 0.546) and substantial agreement for MCS (ICC = 0.931). For 95% of individual patients, the difference between change in SF-36 and SF-12 scores varied between -14.0 and 16.9 for PCS and between -7.8 and 8.7 for MCS. Cross-sectional results showed fair agreement for PCS (ICC = 0.597) and substantial agreement for MCS (ICC = 0.943). CONCLUSIONS On a group level, SF-12 can reliably reproduce MCS in pituitary patients, although PCS is less well correlated. However, individual differences between SF-36 and SF-12 can be large. For pituitary diseases, alternative strategies are needed for concise, but comprehensive patient-reported outcome measurement.
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Affiliation(s)
- Merel van der Meulen
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands.
| | - Amir H Zamanipoor Najafabadi
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden/The Hague, The Netherlands
| | - Daniel J Lobatto
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden/The Hague, The Netherlands
| | - Cornelie D Andela
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden/The Hague, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
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Meregaglia M, Whittal A, Nicod E, Drummond M. 'Mapping' Health State Utility Values from Non-preference-Based Measures: A Systematic Literature Review in Rare Diseases. PHARMACOECONOMICS 2020; 38:557-574. [PMID: 32152892 DOI: 10.1007/s40273-020-00897-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The use of patient-reported outcome measures (PROMs) to monitor the effects of disease and treatment on patient symptomatology and daily life is increasing in rare diseases (RDs) (i.e. those affecting less than one in 2000 people); however, these instruments seldom yield health state utility values (HSUVs) for cost-utility analyses. In such a context, 'mapping' allows HSUVs to be obtained by establishing a statistical relationship between a 'source' (e.g. a disease-specific PROM) and a 'target' preference-based measure [e.g. the EuroQol-5 Dimension (EQ-5D) tool]. OBJECTIVE This study aimed to systematically review all published studies using 'mapping' to derive HSUVs from non-preference-based measures in RDs, and identify any critical issues related to the main features of RDs, which are characterised by small, heterogeneous, and geographically dispersed patient populations. METHODS The following databases were searched during the first half of 2019 without time, study design, or language restrictions: MEDLINE (via PubMed), the School of Health and Related Research Health Utility Database (ScHARRHUD), and the Health Economics Research Centre (HERC) database of mapping studies (version 7.0). The keywords combined terms related to 'mapping' with Orphanet's list of RD indications (e.g. 'acromegaly') in addition to 'rare' and 'orphan'. 'Very rare' diseases (i.e. those with fewer than 1000 cases or families documented in the medical literature) were excluded from the searches. A predefined, pilot-tested extraction template (in Excel®) was used to collect structured information from the studies. RESULTS Two groups of studies were identified in the review. The first group (n = 19) developed novel mapping algorithms in 13 different RDs. As a target measure, the majority used EQ-5D, and the others used the Short-Form Six-Dimension (SF-6D) and 15D; most studies adopted ordinary least squares (OLS) regression. The second group of studies (n = 9) applied previously published algorithms in non-RDs to comparable RDs, mainly in the field of cancer. The critical issues relating to 'mapping' in RDs included the availability of very few studies, the relatively high number of cancer studies, and the absence of research in paediatric RDs. Moreover, the reviewed studies recruited small samples, showed a limited overlap between RD-specific and generic PROMs, and highlighted the presence of cultural and linguistic factors influencing results in multi-country studies. Lastly, the application of existing algorithms developed in non-RDs tended to produce inaccuracies at the bottom of the EQ-5D scale, due to the greater severity of RDs. CONCLUSIONS More research is encouraged to develop algorithms for a broader spectrum of RDs (including those affecting young children), improve mapping study quality, test the generalisability of algorithms developed in non-RDs (e.g. HIV) to rare variants or evolutions of the same condition (e.g. AIDS wasting syndrome), and verify the robustness of results when mapped HSUVs are used in cost-utility models.
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Affiliation(s)
- Michela Meregaglia
- Research Centre on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
| | - Amanda Whittal
- Research Centre on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Elena Nicod
- Research Centre on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
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Leães CGS, Fernandes MV, Alves L, Araújo B, Rech CGSL, Ferreira NP, Rosa LHT, Pereira-Lima JFS, Oliveira MC. Assessment of Anthropometric and Physical Health Indicators before and after Pituitary Surgery in Patients with Nonfunctioning Pituitary Adenomas, Acromegaly, and Cushing Disease. Indian J Endocrinol Metab 2019; 23:473-479. [PMID: 31741909 PMCID: PMC6844162 DOI: 10.4103/ijem.ijem_301_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Individuals with pituitary adenomas may have organic consequences of their disease or therapy, and psychological changes can compromise their quality of life (QoL). This study aimed to determine the anthropometric profile and health indicators of patients with pituitary adenoma before and after pituitary surgery. METHODS Forty-four patients were included in this study. Out of these, 22 patients had nonfunctioning adenomas (50%), 17 acromegaly (38.6%), and 5 patients with Cushing's disease (11.4%). Anthropometric measurements included body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). Health indicators included body fat percentage (BF%), basal metabolic rate (BMR), maximal oxygen uptake (VO2 max), and hand grip strength. Physical activity level (the International Physical Activity Questionnaire [IPAQ]), subjective perception of health, body image (Body Shape Questionnaire), body satisfaction (Stunkard Figure Rating Scale) were used. RESULTS The mean patient age was 47.2 ± 14.6 years; of which 25 were women (56.8%). Before surgery, 75.0% were overweight or obese, 84.1% had WC with risk of metabolic complications, and 90.0% had WHR with cardiovascular risk. There was a high BF% in 56.4% of cases, low BMR in 65.1%, lower VO2 max in 16.2%, and below-average grip strength in 88.6%. Hypopituitary patients had poorer cardiorespiratory fitness. The IPAQ showed reduction in physical activity, and 79.5% of patients were dissatisfied with their body image. Patients with nonfunctioning adenomas had better perception of their health while those with Cushing's disease had more distorted body image. Postoperatively, patients with acromegaly showed improvement in WHR and physical activity level, and patients with Cushing's disease showed improvement in anthropometric variables. CONCLUSIONS These findings emphasize the need for continuous monitoring of this population for anthropometric indicators associated with metabolic and cardiovascular comorbidities as well as body satisfaction.
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Affiliation(s)
- Cyro G. S. Leães
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Matheus V. Fernandes
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Luiza Alves
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Bruna Araújo
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Carolina G. S. L. Rech
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Nelson P. Ferreira
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Luis H. T. Rosa
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, UFCSPA, Porto Alegre, RS, Brasil
| | - Júlia F. S. Pereira-Lima
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
| | - Miriam C. Oliveira
- Programa de Pós-Graduação em Patologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
- Centro de Neuroendocrinologia, Complexo Hospitalar Santa Casa, UFCSPA, Porto Alegre, RS, Brasil
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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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9
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Scalp hair cortisol and testosterone levels in patients with sarcoidosis. PLoS One 2019; 14:e0215763. [PMID: 31199799 PMCID: PMC6568399 DOI: 10.1371/journal.pone.0215763] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background Patients with sarcoidosis often experience fatigue and psychological distress, but little is known about the etiology of these conditions. While serum and saliva steroid hormones are used to monitor acute steroid levels, scalp hair analysis is a relatively new method enabling measurement of long-term steroid levels, including hair cortisol reflecting chronic stress. We investigated whether scalp hair cortisol and testosterone levels differ between sarcoidosis patients both with and without fatigue and general population controls. Additionally, we studied if these hormones could serve as objective biomarkers for psychological distress in patients with sarcoidosis. Methods We measured hair steroid levels using liquid chromatography–tandem mass spectrometry in glucocorticoid naïve sarcoidosis patients. Patients completed the Perceived Stress Scale, Fatigue Assessment Scale, Hospital Anxiety and Depression Scale and Short Form 36 (SF-36). Hair steroid levels from 293 participants of the population-based Lifelines cohort study served as controls. Results Thirty-two patients (14 males) were included. Hair cortisol, but not testosterone, concentrations were significantly higher in patients with sarcoidosis than in general population controls (mean 6.6 versus 2.7 pg/mg, p<0.001). No differences were found in hair cortisol and testosterone levels between fatigued and non-fatigued patients with sarcoidosis. Hair cortisol of sarcoidosis patients correlated significantly with anxiety (r = 0.47, p = 0.01), depression (r = 0.46, p = 0.01), and SF-36 mental domain (r = -0.38, p = 0.03), but not with fatigue. Conclusions Patients with sarcoidosis have chronically higher levels of the stress hormone cortisol than the normal population, while testosterone levels in hair did not differ. Hair cortisol levels were positively related to subjective measures of psychological distress, but not to fatigue. Our study shows that hair cortisol is a promising non-invasive biomarker for psychological distress in patients with sarcoidosis. Trial registration ClinicalTrials.gov: NCT03108547. Registered 31 March 2017, retrospectively registered.
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Feelders RA, Newell-Price J, Pivonello R, Nieman LK, Hofland LJ, Lacroix A. Advances in the medical treatment of Cushing's syndrome. Lancet Diabetes Endocrinol 2019; 7:300-312. [PMID: 30033041 DOI: 10.1016/s2213-8587(18)30155-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 01/05/2023]
Abstract
Cushing's syndrome is associated with multisystem morbidity and, when suboptimally treated, increased mortality. Medical therapy is an option for patients if surgery is not successful and can be classified into pituitary-directed drugs, steroid synthesis inhibitors, and glucocorticoid receptor antagonists. In the last decade there have been new developments in each drug category. Targeting dopamine and somatostatin receptors on corticotroph adenomas with cabergoline or pasireotide, or both, controls cortisol production in up to 40% of patients. Potential new targets in corticotroph adenomas include the epidermal growth factor receptor, cyclin-dependent kinases, and heat shock protein 90. Osilodrostat and levoketoconazole are new inhibitors of steroidogenesis and are currently being evaluated in multicentre trials. CORT125134 is a new selective glucocorticoid receptor antagonist under investigation. We summarise the drug therapies for various forms of Cushing's syndrome and focus on emerging drugs and drug targets that have the potential for new and effective tailor-made pharmacotherapy for patients with Cushing's syndrome.
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Affiliation(s)
- Richard A Feelders
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, Rotterdam, Netherlands.
| | - John Newell-Price
- Academic Unit of Endocrinology, University of Sheffield, Sheffield, UK
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Lynnette K Nieman
- Eunice Kennedy Shriver National Institute of Diabetes and Kidney Disease, National Institutes of Health, Bethesda, MD, USA
| | - Leo J Hofland
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Andre Lacroix
- Division of Endocrinology, Department of Medicine and Research Centre, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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Depaoli S, Tiemensma J, Felt JM. Assessment of health surveys: fitting a multidimensional graded response model. PSYCHOL HEALTH MED 2019; 23:13-31. [PMID: 29544349 DOI: 10.1080/13548506.2018.1447136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The multidimensional graded response model, an item response theory (IRT) model, can be used to improve the assessment of surveys, even when sample sizes are restricted. Typically, health-based survey development utilizes classical statistical techniques (e.g. reliability and factor analysis). In a review of four prominent journals within the field of Health Psychology, we found that IRT-based models were used in less than 10% of the studies examining scale development or assessment. However, implementing IRT-based methods can provide more details about individual survey items, which is useful when determining the final item content of surveys. An example using a quality of life survey for Cushing's syndrome (CushingQoL) highlights the main components for implementing the multidimensional graded response model. Patients with Cushing's syndrome (n = 397) completed the CushingQoL. Results from the multidimensional graded response model supported a 2-subscale scoring process for the survey. All items were deemed as worthy contributors to the survey. The graded response model can accommodate unidimensional or multidimensional scales, be used with relatively lower sample sizes, and is implemented in free software (example code provided in online Appendix). Use of this model can help to improve the quality of health-based scales being developed within the Health Sciences.
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Affiliation(s)
- Sarah Depaoli
- a Psychological Sciences , University of California, Merced , Merced , CA , USA
| | - Jitske Tiemensma
- a Psychological Sciences , University of California, Merced , Merced , CA , USA
| | - John M Felt
- a Psychological Sciences , University of California, Merced , Merced , CA , USA
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12
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13
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Knoble N, Nayroles G, Cheng C, Arnould B. Illustration of patient-reported outcome challenges and solutions in rare diseases: a systematic review in Cushing's syndrome. Orphanet J Rare Dis 2018; 13:228. [PMID: 30567582 PMCID: PMC6299940 DOI: 10.1186/s13023-018-0958-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/20/2018] [Indexed: 12/15/2022] Open
Abstract
Rare diseases are often not fully understood and efforts put in investigating it from patient perspective are usually met with challenges. We performed a systematic literature review (SLR) for the last 20 years in Cushing's Syndrome (CS) to illustrate Patient-Reported Outcome (PRO) challenges, and show what solutions were found.PROs and other Clinical Outcome Assessment (COA) used with CS patients were reviewed in 36 studies. Two CS-specific Health Related Quality of Life (HRQL) measures were identified (i.e., CushingQoL, Tuebingen CD-25), as well as depression and neurocognitive measures. For CS-specific HRQL measures, the CushingQoL was the most widely used measure due in part to being the first CS-specific HRQL measure developed. With algorithms mapping the CushingQoL to both the SF-6D and EQ-5D, the CushingQoL could be used to facilitate economic modelling studies in the absence of a generic HRQL measure. While the CushingQoL offers only the global scale and two subscales compared to the six subscales of the Tuebingen CD-25, there is not yet adequate statistical validation data available for the Tuebingen CD-25 to suggest it can withstand the scrutiny of review by multiple stakeholders. Results of this review indicate that the inclusion of a measure of depressive symptoms, such as the BDI-II or similar measure, would be reasonable to include given the high level of comorbidity of depression among CS patients. A brief neurocognitive performance outcome, such as Trail Making tasks A and D or Digit Symbol, could help inform the interpretation of HRQL results. Neurocognitive differences may be an unassessed mediator of HRQL outcomes, partly accounting for the persistence of depressive symptoms and HRQL deficits despite treatment. Results suggest that HRQL improvements are possible within this population. These results are limited by small sample sizes and pre/post study design.CS showcases the difficulties encountered in measuring PROs in rare diseases. A solution for this specific case was developed in the form of dedicated PRO instruments, the CushingQOL and the Tuebingen-25. However, some aspects of CS may not be fully answered or not yet validated (e.g., depressive and cognitive symptoms). Further research needs to be done to address them.
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Affiliation(s)
- Naomi Knoble
- Mapi, an ICON plc Company, 27 rue de la Villette, 69003 Lyon, France
| | | | - Cherry Cheng
- Ipsen Pharma, 65 quai Georges Gorse, 92560 Boulogne-Billancourt, France
| | - Benoit Arnould
- Mapi, an ICON plc Company, 27 rue de la Villette, 69003 Lyon, France
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14
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Machado MC, Fragoso MCBV, Moreira AC, Boguszewski CL, Vieira Neto L, Naves LA, Vilar L, Araújo LAD, Musolino NRC, Miranda PAC, Czepielewski MA, Gadelha MR, Bronstein MD, Ribeiro-Oliveira A. A review of Cushing's disease treatment by the Department of Neuroendocrinology of the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:87-105. [PMID: 29694638 PMCID: PMC10118687 DOI: 10.20945/2359-3997000000014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/02/2017] [Indexed: 11/23/2022]
Abstract
The treatment objectives for a patient with Cushing's disease (CD) are remission of hypercortisolism, adequate management of co-morbidities, restoration of the hypothalamic-pituitary-adrenal axis, preservation of fertility and pituitary function, and improvement of visual defects in cases of macroadenomas with suprasellar extension. Transsphenoidal pituitary surgery is the main treatment option for the majority of cases, even in macroadenomas with low probability of remission. In cases of surgical failure, another subsequent pituitary surgery might be indicated in cases with persistent tumor imaging at post surgical magnetic resonance imaging (MRI) and/or pathology analysis of adrenocorticotropic hormone-positive (ACTH+) positive pituitary adenoma in the first procedure. Medical treatment, radiotherapy and adrenalectomy are the other options when transsphenoidal pituitary surgery fails. There are several options of medical treatment, although cabergoline and ketoconazole are the most commonly used alone or in combination. Novel treatments are also addressed in this review. Different therapeutic approaches are frequently needed on an individual basis, both before and, particularly, after surgery, and they should be individualized. The objective of the present review is to provide the necessary information to achieve a more effective treatment for CD. It is recommended that patients with CD be followed at tertiary care centers with experience in treating this condition.
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Affiliation(s)
- Márcio Carlos Machado
- Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Candida Barisson Vilares Fragoso
- Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ayrton Custódio Moreira
- Divisão de Endocrinologia e Metabologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - César Luiz Boguszewski
- Serviço de Endocrinologia e Metabologia (SEMPR), Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Leonardo Vieira Neto
- Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Luciana A Naves
- Serviço de Endocrinologia, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brasil
| | - Lucio Vilar
- Serviço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | | | - Nina Rosa Castro Musolino
- Divisão de Neurocirurgia Funcional, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Mauro A Czepielewski
- Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Monica R Gadelha
- Serviço de Endocrinologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marcello Delano Bronstein
- Unidade de Neuroendocrinologia, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Antônio Ribeiro-Oliveira
- Serviço de Endocrinologia, Hospital de Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Winter SD, Depaoli S, Tiemensma J. Assessing Differences in How the CushingQoL Is Interpreted Across Countries: Comparing Patients From the U.S. and the Netherlands. Front Endocrinol (Lausanne) 2018; 9:368. [PMID: 30042732 PMCID: PMC6048230 DOI: 10.3389/fendo.2018.00368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 06/18/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Cultural factors influence how individuals define, evaluate, and approach their quality of life (QoL). The CushingQoL is a widely used disease-specific questionnaire to assess QoL in patients with Cushing's syndrome. However, there is no information about potential cross-country differences in the way patients interpret the items on the CushingQoL. Thus, the current study examined if the CushingQoL is interpreted in the same way across nationalities. Methods: Patients from the U.S. (n = 260) and the Netherlands (n = 103) were asked to fill out the CushingQoL and a short demographics survey. Measurement invariance testing was utilized to explore whether or not the patient samples from the U.S. and the Netherlands interpreted items on the CushingQoL in the same way. Results: A two-subscale scoring approach was used for the CushingQoL. Model fit was good for the U.S. sample (e.g., CFI = 0.983; TLI = 0.979), as well as the Dutch sample (e.g., CFI = 0.971; TLI = 0.964). Invariance testing revealed that three of the 12 items on the CushingQoL were interpreted differently across the groups. These items are all related to psychosocial issues (e.g., irritable mood and worrying about one's health). Items assessing physical aspects of QoL did not vary across the U.S. and Dutch samples. Conclusions: Interpreting results from the CushingQoL requires careful consideration of country of residence, as this appears to impact the interpretation of the questionnaire.
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Santos A, Resmini E, Pascual JC, Crespo I, Webb SM. Psychiatric Symptoms in Patients with Cushing's Syndrome: Prevalence, Diagnosis and Management. Drugs 2017; 77:829-842. [PMID: 28393326 DOI: 10.1007/s40265-017-0735-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cushing's syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach. The aim of this article is to review data on the prevalence, diagnosis and management of psychiatric symptoms seen in patients with CS and to propose therapeutic approaches that may be followed in clinical practice. The prevalence of different psychiatric disorders has been described in both the active phase and after CS remission. Patients may not talk spontaneously about psychiatric symptoms they present, thus clinicians should ask directly about them. We recommend the use of screening tools in clinical practice to detect and treat these symptoms promptly. Even if reference endocrinologists cannot perform a definite psychiatric diagnosis, it will be important to ask patients directly about the presence of symptoms and refer if necessary to a psychiatrist. Additionally, patient information and educational programmes could be useful to manage psychiatric symptoms and to improve quality of life in patients with CS.
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Affiliation(s)
- Alicia Santos
- Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugenia Resmini
- Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Juan Carlos Pascual
- Department of Psychiatry, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Iris Crespo
- Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susan M Webb
- Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Pires P, Santos A, Vives-Gilabert Y, Webb SM, Sainz-Ruiz A, Resmini E, Crespo I, de Juan-Delago M, Gómez-Anson B. White matter involvement on DTI-MRI in Cushing's syndrome relates to mood disturbances and processing speed: a case-control study. Pituitary 2017; 20:340-348. [PMID: 28332051 DOI: 10.1007/s11102-017-0793-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Cushing's syndrome (CS) is an endocrine disorder due to prolonged exposure to cortisol. Recently, microstructural white matter (WM) alterations detected by diffusion tensor imaging (DTI) have been reported in CS patients, and related to depression, but other functional significances. remain otherwise unclear. We aimed at investigating in more depth mood symptoms in CS patients, and how these relate to cognition (information processing speed), and to WM alterations on DTI. METHODS The sample comprised 35 CS patients and 35 healthy controls. Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, State-Trait Anxiety Inventory (STAI) to assess anxiety, and processing speed was measured by the Symbol Digit Modalities Test (SDMT). DTI studies were acquired using a 3-Tesla Philips-Achieva MR-facility. Voxelwise statistical analysis of fractional anisotropy (FA), mean, axial and radial diffusivities (MD, AD, RD) data were performed using FMRIB Software Library. Correlation analysis were obtained between mood and processing speed variables, and FA, MD, AD and RD values, taking both CS patients and healthy controls. RESULTS Active, controlled and cured CS patients showed greater depression (F = 12.4, p < 0.001), anxious state (F = 4.8, p = 0.005) and anxious trait (F = 9.6, p < 0.001) scores, than controls. Using the entire sample, depression scores correlated negatively to FA and positively to RD values. Although there were no differences in processing speed between groups, SDMT scores correlated positively to both FA and AD values. CONCLUSIONS There were greater depressive and anxious symptoms in CS patients than in healthy controls, but no difference in processing speed. However, DTI is related to depression and information processing speed in CS.
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Affiliation(s)
- Patricia Pires
- INNDACYT, CR Laureà Miró, 107, Sant Feliu de Llobregat, Barcelona, Spain
- Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia Santos
- Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Yolanda Vives-Gilabert
- INNDACYT, CR Laureà Miró, 107, Sant Feliu de Llobregat, Barcelona, Spain
- Port d'Informació Científica (PIC), Campus UAB Edifici D, Bellaterra, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Aitor Sainz-Ruiz
- Port d'Informació Científica (PIC), Campus UAB Edifici D, Bellaterra, Barcelona, Spain
- Institut de Fisica d'Altes Energies (IFAE), Campus UAB Edifici C, Bellaterra, Barcelona, Spain
| | - Eugenia Resmini
- Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Iris Crespo
- Endocrinology/Medicine Departments, Hospital Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Manel de Juan-Delago
- Neuroradiology Unit, Hospital Sant Pau, IIB-Sant Pau, and UAB, C/ San Antoni Maria Claret 167, 08025, Barcelona, Spain
| | - Beatriz Gómez-Anson
- Neuroradiology Unit, Hospital Sant Pau, IIB-Sant Pau, and UAB, C/ San Antoni Maria Claret 167, 08025, Barcelona, Spain.
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León-Justel A, Madrazo-Atutxa A, Alvarez-Rios AI, Infantes-Fontán R, Garcia-Arnés JA, Lillo-Muñoz JA, Aulinas A, Urgell-Rull E, Boronat M, Sánchez-de-Abajo A, Fajardo-Montañana C, Ortuño-Alonso M, Salinas-Vert I, Granada ML, Cano DA, Leal-Cerro A. A Probabilistic Model for Cushing's Syndrome Screening in At-Risk Populations: A Prospective Multicenter Study. J Clin Endocrinol Metab 2016; 101:3747-3754. [PMID: 27490917 DOI: 10.1210/jc.2016-1673] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed. OBJECTIVE To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test. DESIGN Observational, prospective, multicenter. SETTING Referral hospital. PATIENTS A cohort of 353 patients attending endocrinology units for outpatient visits. INTERVENTIONS All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS. MAIN OUTCOME MEASURES Diagnosis or exclusion of CS. RESULTS Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%. CONCLUSIONS We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
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Affiliation(s)
- Antonio León-Justel
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ainara Madrazo-Atutxa
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ana I Alvarez-Rios
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Rocio Infantes-Fontán
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Juan A Garcia-Arnés
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Juan A Lillo-Muñoz
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Anna Aulinas
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Eulàlia Urgell-Rull
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Mauro Boronat
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Ana Sánchez-de-Abajo
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Carmen Fajardo-Montañana
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Mario Ortuño-Alonso
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Isabel Salinas-Vert
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Maria L Granada
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - David A Cano
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
| | - Alfonso Leal-Cerro
- Medicine Department (A.L.-J.), Huelva University Hospital, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Unidad de Gestión Clínica de Endocrinología y Nutrición (A.M.-A., D.A.C., A.L.-C.), IBiS, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain; Department of Clinical Biochemistry (A.I.A.-R.), Virgen del Rocío University Hospital (IBiS/CSIC/SAS/University of Seville), 41013 Sevilla, Spain; Servicio de Bioquímica (R.I.-F.), Sección Hormonas especiales, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain; Department of Clinical Endocrinology and Nutrition (J.A.G.-A.), Carlos Haya Hospital, 29010 Málaga, Spain; Hospital Regional Universitario de Málaga (J.A.L.-M.), 29010 Málaga, Spain; Pituitary Disease Research Group/Department Endocrinology/Medicine (A.A.), Hospital Sant Pau, Universitat Autónoma de Barcelona and CIBERER U747, ISCIII, 08025 Bellaterra, Barcelona, Spain; Clinical Biochemistry Department (E.U.-R.), Hospital de Sant Pau, 08025 Barcelona, Spain; Sección de Endocrinología y Nutrición (M.B.), Hospital Universitario Insular, Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain; Servicio de Bioquímica Clínica (A.S.-d.-A.), Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain; Hospital Universitario de La Ribera (C.F.-M., M.O.-A.), 46600 Alzira, Valencia, Spain; Servicio Endocrinología y Nutrición (I.S.-V.) and Servicio de Bioquímica (M.L.G.), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain
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Abstract
AbstractBackground: Our study evaluated the perioperative quality of life (QoL) in Cushing’s disease (CD) patients, along with correlations between patient variables and cure rate. Methods: The 36-item Short-Form Health Survey (SF)-36 questionnaire was used to assess perioperative QoL. Patients completed one survey preoperatively and two surveys postoperatively. Retrospective chart review was conducted to collect SF-36 data as well as examine variables including: age, hospital stay, size of tumour, pathological diagnosis, timing of cure, and complication rates. Statistical analysis was conducted on the scores reported by the SF-36, and were compared with the normal Canadian population values, and to a sample of QoL from nonfunctioning pituitary tumour patients. This project was approved by University of British Columbia Research Ethics Board #H15-01572. Results: In general, CD patients have relatively poor QoL that does improve as expected when cured, but not quite to normal levels. Factors associated with cure included presence of macroadenoma, confirmatory pathology, and patient age. Postoperative timing of cure appears to affect the durability of cure, with an immediate cure having a higher durability rate than delayed cure. Most recurrences occurred within 10 months postoperatively. Conclusions: This review of the perioperative QoL in CD helps to illustrate how QoL changes throughout the treatment process, how QoL compares to normal Canadian population levels, and how QoL compares to patients with nonfunctioning pituitary adenomas. As treatment outcome has such a high impact on QoL, the variables identified in this study will help to better inform patients about the treatment course.
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Tiemensma J, Depaoli S, Felt JM. Using subscales when scoring the Cushing's quality of life questionnaire. Eur J Endocrinol 2016; 174:33-40. [PMID: 26431845 DOI: 10.1530/eje-15-0640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/02/2015] [Indexed: 11/08/2022]
Abstract
CONTEXT Patients in long-term remission of Cushing's syndrome (CS) commonly report impaired quality of life (QoL). The CushingQoL questionnaire is a disease-specific QoL questionnaire for patients diagnosed with CS. The developers of the CushingQoL recommend using a global (total) score to assess QoL. However, the global score does not capture all aspects of QoL as outlined by the World Health Organization (WHO). OBJECTIVE The aim of the study was to compare the performance of different scoring options to determine the optimal method for the CushingQoL. DESIGN AND PATIENTS Patients in remission from CS (n=341) were recruited from the Cushing's Syndrome Research Foundation's email listserv and Facebook page, and asked to complete the CushingQoL and a short demographics survey. RESULTS Using an exploratory analysis, adequate model fit was obtained for the global score, as well as a 2-subscale (psychosocial issues and physical problems) scoring solution. Confirmatory methods were performed to identify the optimal scoring solution. Both the global score and the 2-subscale scoring solution showed adequate model fit. However, a χ(2) difference test indicated that the 2-subscale scoring solution was a significantly better fit than the global score (P<0.05). CONCLUSION If doctors or researchers would like to tease apart physical and psychosocial issues, the 2-subscale scoring solution would be recommended, since this solution showed to be optimal in scoring the CushingQoL. Regardless of the scoring solution used, the CushingQoL has proven to be a valuable resource for assessing health-related QoL in patients with CS.
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Affiliation(s)
- Jitske Tiemensma
- Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA
| | - Sarah Depaoli
- Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA
| | - John M Felt
- Psychological SciencesUniversity of California, Merced, 5200 North Lake Road, Merced, California 95343, USA
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Sbiera S, Deutschbein T, Weigand I, Reincke M, Fassnacht M, Allolio B. The New Molecular Landscape of Cushing's Disease. Trends Endocrinol Metab 2015; 26:573-583. [PMID: 26412158 DOI: 10.1016/j.tem.2015.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/05/2015] [Accepted: 08/08/2015] [Indexed: 11/21/2022]
Abstract
Cushing's disease (CD) is caused by corticotropin-secreting pituitary adenomas and results in substantial morbidity and mortality. Its molecular basis has remained poorly understood until the past few years, when several proteins and genes [such as testicular orphan nuclear receptor 4 (TR4) and heat shock protein 90 (HSP90)] were found to play key roles in the disease. Most recently, mutations in the gene of ubiquitin-specific peptidase 8 (USP8) increasing its deubiquination activity were discovered in a high percentage of corticotroph adenomas. Here, we will discuss emerging insights in the molecular alterations that finally result in CD. The therapeutic potential of these findings needs to be carefully evaluated in the near future, hopefully resulting in new treatment options for this devastating disorder.
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Affiliation(s)
- Silviu Sbiera
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Timo Deutschbein
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Isabel Weigand
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
| | - Martin Reincke
- Endocrine Research Unit, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Martin Fassnacht
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
| | - Bruno Allolio
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, University of Würzburg, Würzburg, Germany
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