Psychological well-being and illness perceptions in patients with hypopituitarism

Sheehan syndrome: a current approach to a dormant disease

Sheehan syndrome (SS) is postpartum pituitary necrosis leading to severe hypopituitarism. Severe bleeding during delivery and postpartum period results in ischemic necrosis of the enlarged pituitary gland during pregnancy. The improved obstetrical care decreased the incidence of SS significantly, however SS should always be kept in mind in the etiologies of hypopitutarism in women which can be easily recognized by medical history of the patient. The nonspecific signs and symptoms of hypopituitarism result in significant delay in diagnosis and treatment. The diagnostic delay makes the patients to expose hypopituitarism without essential replacement therapies leading to increased morbidity and mortality of the patients. Awareness of physicians about SS is critical for the diagnosis of the disease. In this review, the epidemiology, pathophysiology, clinical manifestations and treatment of SS are discussed in the light of recent studies.

Quality of life and profile of mood states in patients with childhood-onset hypopituitarism and growth hormone deficiency during the discontinuation of growth hormone replacement therapy at the transition from adolescence to adulthood

THE AIM

to assess quality of life (QoL) and profile of mood states in patients with childhood-onset hypopituitarism and growth hormone (GH) deficiency during the discontinuation of recombinant growth hormone (rGH) replacement therapy at the transition from adolescence to adulthood.

METHODS

mood states and QoL were assessed in 136 (85 men, 51 women, age 16.8 ± 1.1 years) patients during discontinuation of rGH replacement and 82 (40 men, 42 women, age 16.5 ± 1.7 years) control individuals using the Profile of Mood States2 (POMS2) and the Quality of Life - Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) questionnaires.

RESULTS

No difference in QoL was between patients and controls, but patients had higher levels of tension-anxiety (median 9.0 score vs. 6.0 score, p < 0.001), depression-dejection (median 9.0 score vs. 8.0 score, p = 0.042), fatigue-inertia (median 9.0 score vs. 6.0 score, p < 0.001), confusion-bewilderment (median 4.0 score vs. 3.0 score, p = 0.003) than controls. Basal cortisol concentration correlated negatively with QoL-AGHDA score (r = -0.288, p = 0.012), depression-dejection score (r = -0.317, p = 0.005). Height correlated negatively with anger-hostility (r = -0.223, p = 0.010), fatigue-inertia (r = -0.188, p = 0.030) scores. Body mass index (BMI) correlated positively with fatigue-inertia score (r = 0.181, p = 0.040). Age at the discontinuation of rGH replacement correlated negatively with QoL-AGHDA score (r = -0.204, p = 0.026), depression-dejection (r = -0.460, p = 0.021), anger-hostility (r = -0.190, p = 0.040), fatigue-inertia (r = -0.205, p = 0.026) scores.

CONCLUSION

mood states (higher tension-anxiety, depression-dejection, fatigue-inertia, confusion-bewilderment), but not disease-specific QoL are impaired in patients with childhood-onset growth hormone deficiency during the discontinuation of rGH replacement therapy at the transition from adolescence to adulthood.

Cognition and psychological wellbeing in hypopituitary patients

Hypopituitarism (HP) frequently occurs in patients presenting with sellar masses and despite recent advances in therapeutic options, HP patients consistently suffer from impaired quality of life due to psychological distress and cognitive dysfunction. These neurocognitive complications tend to persist in spite of surgical or biochemical remission of the disease making it especially challenging to segregate the effect of HP per se from other comorbidities such as the effect of tumour, surgery, radiation therapy, or complications caused by excess hormone production. Regardless, there is ample evidence to suggest that receptors for various pituitary hormones are abundantly expressed in key areas of central nervous system that are associated with memory and behaviour function and HP is also associated with poor sleep which can further exacerbate neurocognitive dysfunction. There is also evidence that hormonal replacement in HP patients partially restores these neurocognitive functions and improves sleep disorders. However, there is a need for creating better awareness among healthcare providers interacting with HP patients to enhance an earlier recognition of these disorder and their impact on quality of life despite initial remission. Importantly, there is a need to not only develop better and more cost-effective replacement therapies that would closely mimic the physiological hormonal release patterns, but also develop coping strategies for HP patients suffering from these complications.

Related factors to illness perception of individuals with diabetic foot ulcers: A structural equation modelling test

BACKGROUND

Diabetic foot is a common and severe complication of diabetes with limited movement, emotional distress, and poor quality of life. Illness perception was introduced to improve patients' psychological status and quality of life with diabetic foot ulcers. The aim of the study is to explore the related factors of illness perception, and to structure an illness perception model of patients with diabetic foot ulcers.

METHODS

We recruited 208 patients with diabetic foot ulcers from six hospitals from April 2021 to February 2022. A multicentered cross-sectional study was conducted to collect the data. Questionnaires included illness perception, coping behavior, emotional status, and quality of life. We performed multiple linear regression analysis with illness perception as the dependent variable, and evaluated the goodness of fit of the resulting structural equations models based on covariance structural analysis.

RESULTS

Illness perception was negatively related to coping behavior and quality of life, and it was positively correlated with yield-coping behavior, anxiety, and depression. The pain, diabetes duration, quality of life, yield-coping strategy, and sex were the factors that affected illness perception in patients with DFUs (P＜0.05). The resulting model was found to exhibit goodness of fit.

CONCLUSION

Illness perception had an especially strong and direct impact on quality of life, depression, and anxiety. Therefore, it is significant to improve illness perception in patients with DFUs, and provide positive support based on cognitive behavioral therapy to improve illness perception, quality of life, and emotional status.

The association between persistent cognitive difficulties and depression and functional outcomes in people with major depressive disorder

BACKGROUND

Cognitive symptoms are common during and following episodes of depression. Little is known about the persistence of self-reported and performance-based cognition with depression and functional outcomes.

METHODS

This is a secondary analysis of a prospective naturalistic observational clinical cohort study of individuals with recurrent major depressive disorder (MDD; N = 623). Participants completed app-based self-reported and performance-based cognitive function assessments alongside validated measures of depression, functional disability, and self-esteem every 3 months. Participants were followed-up for a maximum of 2-years. Multilevel hierarchically nested modelling was employed to explore between- and within-participant variation over time to identify whether persistent cognitive difficulties are related to levels of depression and functional impairment during follow-up.

RESULTS

508 individuals (81.5%) provided data (mean age: 46.6, s.d.: 15.6; 76.2% female). Increasing persistence of self-reported cognitive difficulty was associated with higher levels of depression and functional impairment throughout the follow-up. In comparison to low persistence of objective cognitive difficulty (<25% of timepoints), those with high persistence (>75% of timepoints) reported significantly higher levels of depression (B = 5.17, s.e. = 2.21, p = 0.019) and functional impairment (B = 4.82, s.e. = 1.79, p = 0.002) over time. Examination of the individual cognitive modules shows that persistently impaired executive function is associated with worse functioning, and poor processing speed is particularly important for worsened depressive symptoms.

CONCLUSIONS

We replicated previous findings of greater persistence of cognitive difficulty with increasing severity of depression and further demonstrate that these cognitive difficulties are associated with pervasive functional disability. Difficulties with cognition may be an indicator and target for further treatment input.

Why do patients with hypopituitarism still present an increased mortality?

Hypopituitarism is defined as a lack or decreased secretion of one or several pituitary hormones. It can result from diseases of the pituitary gland or from pathologies of the superior regulatory center, i.e. the hypothalamus, thereby decreasing hypothalamic releasing hormones and consequently the pituitary hormones. It is still a rare disease with an estimated prevalence of 30-45 patients/100,000 and an incidence of 4-5/100,000/year. This review summarizes the currently available data with a focus on etiologies of hypopituitarism, evidence on mortality rates in patients with hypopituitarism, temporal trends in mortality , and associated diseases, pathophysiological mechanisms and risk factors that affect mortality risk in these patients.