1
|
Castle-Kirszbaum M, Biermasz N, Kam J, Goldschlager T. Quality of life in Prolactinoma: A systematic review. Pituitary 2024; 27:239-247. [PMID: 38656635 PMCID: PMC11150290 DOI: 10.1007/s11102-024-01392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Prolactinomas are common tumours that significantly reduce quality-of-life (QOL) due to sellar mass effect, secondary hypogonadism, and the peripheral effects of prolactin. Understanding the factors that influence QOL would provide insights into therapeutic targets to optimise patient outcomes and improve wellbeing in prolactinoma. METHODS A systematic review was performed in accordance with the PRISMA statement. Studies that reported patient QoL using validated metrics were included. Bias and methodological rigour were assessed using the MINORS criteria. RESULTS A total of 18 studies were identified studies were available for review, comprising 877 patients. Most were small cross-sectional studies at high risk of bias. Prolactinoma exhibit worse QOL than healthy controls, particularly mental and psychosocial wellbeing. QOL is also worse than patients with non-functional adenomas, but better than those with Cushing's disease and acromegaly. QOL correlates with prolactin levels, and approaches population baseline with prolonged biochemical control. Dopamine agonists and surgery both improve overall QOL, however improvements are more rapid with surgery. CONCLUSION Poor quality of life in prolactinoma is multifactorial, related to biochemical control, side effects of therapy, and sellar mass effect. Targeting persistent symptoms, reducing healthcare costs, and reducing side-effects of therapy are avenues to improving QOL in patients with prolactinoma.
Collapse
Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Surgery, Monash University, Melbourne, Australia.
| | - Nienke Biermasz
- Department of Medicine, Division of Endocrinology, Center for Endocrine Tumors Leiden, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeremy Kam
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
She S, Wu Y, Mu A, Cui F, Zhao X, Shen M. Fatigue, sleep and physical activity in postoperative patients with pituitary adenomas: A survey. Int J Nurs Pract 2024; 30:e13237. [PMID: 38263693 DOI: 10.1111/ijn.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The condition and correlation of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas remain unclear. This survey aimed to evaluate the current status and influencing factors of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas. METHODS Patients undergoing pituitary adenoma resection in two tertiary hospitals from November 2019 to November 2021 were included. The general data questionnaire, Multidimensional Fatigue Inventory (MFI-20), Pittsburgh Sleep Quality Index (PSQI) and international physical activity questionnaire were used for data analysis. RESULTS In total, 184 patients with pituitary adenomas were included. The postoperative patients with pituitary adenomas had a high level of fatigue. In total, 34 (18.5%) patients had low level of physical activity, 76(41.3%) patients had medium level of physical activity and 74 (40.2%) had high level of physical activity. Postoperative time, PSQI, physical activity level and gender were the influencing factors of fatigue in patients with pituitary adenomas (all P < 0.05). CONCLUSIONS Postoperative patients with pituitary adenomas have a higher level of fatigue, and it is related to reduced sleep quality and activity. Relevant nursing measures should be taken according to the influencing factors of fatigue to reduce the fatigue of postoperative patients with pituitary adenomas.
Collapse
Affiliation(s)
- Sunju She
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Yuping Wu
- Department of Neurosurgical Intensive Care Unit, Wuxi Taihu Hospital, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Aiping Mu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feifei Cui
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Xin Zhao
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Meifen Shen
- Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| |
Collapse
|
3
|
Dzialach L, Sobolewska J, Zak Z, Respondek W, Witek P. Prolactin-secreting pituitary adenomas: male-specific differences in pathogenesis, clinical presentation and treatment. Front Endocrinol (Lausanne) 2024; 15:1338345. [PMID: 38370355 PMCID: PMC10870150 DOI: 10.3389/fendo.2024.1338345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Abstract
Prolactinomas (PRLomas) constitute approximately half of all pituitary adenomas and approximately one-fifth of them are diagnosed in males. The clinical presentation of PRLomas results from direct prolactin (PRL) action, duration and severity of hyperprolactinemia, and tumor mass effect. Male PRLomas, compared to females, tend to be larger and more invasive, are associated with higher PRL concentration at diagnosis, present higher proliferative potential, are more frequently resistant to standard pharmacotherapy, and thus may require multimodal approach, including surgical resection, radiotherapy, and alternative medical agents. Therefore, the management of PRLomas in men is challenging in many cases. Additionally, hyperprolactinemia is associated with a significant negative impact on men's health, including sexual function and fertility potential, bone health, cardiovascular and metabolic complications, leading to decreased quality of life. In this review, we highlight the differences in pathogenesis, clinical presentation and treatment of PRLomas concerning the male sex.
Collapse
Affiliation(s)
- Lukasz Dzialach
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Sobolewska
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Zak
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| | - Wioleta Respondek
- Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Brodnowski Hospital, Warsaw, Poland
| | - Przemysław Witek
- Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
4
|
Barlas T, Yalcin MM, Avci DE, Kaplan Y, Akturk M, Toruner FB, Karakoc A, Altinova AE. Sleep quality in patients with non-functioning pituitary adenoma: impact of replacement therapies with an emphasis on the time of hydrocortisone. Pituitary 2023:10.1007/s11102-023-01328-1. [PMID: 37261656 DOI: 10.1007/s11102-023-01328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Sleep disturbances are widespread and associated with pituitary diseases, even those under long-term therapeutic management. The aim of this study was to investigate sleep quality in patients with non-functioning pituitary adenoma (NFPA) and determine the factors that might influence sleep quality, including the detailed features of replacement therapy. METHODS Eighty-two patients with NFPA and 82 age- and gender-matched control subjects were included. Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS) and International Physical Activity Questionnaire (IPAQ) were used. RESULTS In the NFPA group, 57.3% of patients had decreased sleep quality, compared to 35.4% in the control group (p=0.005). Although there was no relationship between the presence of hydrocortisone replacement and sleep quality (p>0.05), a strong positive correlation was observed between PSQI and morning hydrocortisone replacement time in patients with secondary adrenal insufficiency (r=0.834, p<0.001). Diabetes insipidus was found to be significantly higher in the group with decreased sleep quality (p=0.01). Moreover, there was a negative correlation between PSQI and IGF-1 in patients with NFPA (r=-0.259, p=0.01). A multivariate logistic regression model revealed that depression score and free T4 level in the upper half of the normal limit influence the sleep quality of patients with NFPA. CONCLUSION Our study indicated the presence of depression, and a free T4 level in the upper half of the normal range have an impact on the sleep quality of patients with NFPA. The time of hydrocortisone replacement might be important factor for improved sleep quality in patients with secondary adrenal insufficiency.
Collapse
Affiliation(s)
- Tugba Barlas
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Mehmet Muhittin Yalcin
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Yigit Kaplan
- Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Balos Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayhan Karakoc
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altinova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
5
|
Ernersson Å, Bachrack-Lindström M, Landberg E, Ekman B, Wahlberg J. Reduced Health Related Quality of Life, Increased Fatigue, and Daytime Sleepiness in Women with Hyperprolactinemia. Horm Metab Res 2023; 55:266-272. [PMID: 36822222 DOI: 10.1055/a-2042-0712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Prolactin has many physiological effects and seems to be involved in the human quality of life and well-being. The aim of this study was to describe health related quality of life, fatigue and daytime sleepiness in women with untreated hyperprolactinemia. In total 32 women (mean age 37.0±10.9 years) with verified hyperprolactinemia completed a questionnaire including questions on fatigue, measured with the Swedish version of the Fatigue Impact Scale (FIS), propensity to fall in sleep, measured with the Swedish version of the Epworth Sleepiness Scale (ESS), and Health related quality of life (HRQoL), measured by the Short-Form-36 scale (SF-36). For comparison Swedish normative data were used. The women were also interviewed regarding different symptoms related to hyperprolactinemia and the answers were analyzed using qualitative content analysis. HRQoL, as measured with SF-36, was significantly lower in all dimensions, except in physical function, compared to the Swedish reference population. Total FIS was 54.3 (41.1) and mean score on the ESS was 8.7 (4.2) indicating increased fatigue and deterioration in night sleep. The women felt very tired, and several of them rarely felt rested in the morning. The restless night sleep and the fatigue during the daytime got them to feel feeble and sometimes to find it difficult to concentrate, which affected both their mood and life in general. Women diagnosed with hyperprolactinemia reported deterioration in night sleep, increased rate of fatigue, and a reduced health related quality of life in comparison with the reference population.
Collapse
Affiliation(s)
- Åsa Ernersson
- Department of Health, Medicine and Caring Sciences, Division of Nursing Science and Reproductive Health, Linköping University, Linköping, Sweden
| | - Margareta Bachrack-Lindström
- Department of Health, Medicine and Caring Sciences, Division of Nursing Science and Reproductive Health, Linköping University, Linköping, Sweden
| | - Eva Landberg
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
| | - Bertil Ekman
- Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jeanette Wahlberg
- Faculty of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
6
|
Fatigue and Its Contributing Factors in Chinese Patients with Primary Pituitary Adenomas. JOURNAL OF ONCOLOGY 2023; 2023:9876422. [PMID: 36968639 PMCID: PMC10033214 DOI: 10.1155/2023/9876422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2022] [Accepted: 01/29/2023] [Indexed: 03/17/2023]
Abstract
Background. Pituitary adenomas (PAs) refers to a group of benign tumors that develop in the pituitary gland and are often characterized by fatigue. However, fatigue has not been documented in any Chinese research involving people with primary PA. The study sought to examine the prevalence, predictors, and correlation of fatigue with the quality of life (QoL) among PA patients in China. Methods. In total, 203 primary PA patients were included in this cross-sectional study. A series of questionnaires were administered, including the Multidimensional Fatigue Inventory (MFI), M. D. Anderson Symptom Inventory Brain Tumor (MDASI-BT), Short-Form 36 Health Survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS). Data analysis was accomplished by Pearson or Spearman correlations, linear regression, and simple path analysis. Results. Severe fatigue prior to the initial diagnosis and preparation for surgery affected 50% of PA patients. Depression, sleep disturbance, and MDASI-BT symptom total scores were independently able to predict patient fatigue. Sleep disturbance mediates the influence of depression on fatigue (IE sleep = 0.296, 95% CI: LB = 0.148 to UB = 0.471). Conclusions. Chinese patients with primary PA often report experiencing fatigue. Depression and poor sleep quality were shown to be significant contributors to PA patients’ fatigue. Depression affects PA patients’ fatigue directly or indirectly. Medical professionals should take a proactive approach to PA patients suffering from fatigue before initial diagnosis and preoperative preparation to determine necessary interventions early, thus reducing fatigue and ultimately enhancing their QoL.
Collapse
|
7
|
Rusenova Y, Vandeva S, Elenkova A, Petrova G, Kamusheva M. Quality of life of patients with acromegaly: comparison of different therapeutic modalities. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2153670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yanitsa Rusenova
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Silvia Vandeva
- Department of Endocrinology, USHATE “Acad. Ivan Penchev,” Medical University–Sofia, Sofia, Bulgaria
| | - Atanaska Elenkova
- Department of Endocrinology, USHATE “Acad. Ivan Penchev,” Medical University–Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| | - Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Medical University-Sofia, Sofia, Bulgaria
| |
Collapse
|
8
|
Pivonello R, Auriemma RS, Delli Veneri A, Dassie F, Lorusso R, Ragonese M, Liotta M, Sala E, Zarino B, Lai E, Urbani C, Bogazzi F, Mantovani G, Cannavò S, Maffei P, Chiodini P, Colao A. Global psychological assessment with the evaluation of life and sleep quality and sexual and cognitive function in a large number of patients with acromegaly: a cross-sectional study. Eur J Endocrinol 2022; 187:823-845. [PMID: 36165745 PMCID: PMC9782455 DOI: 10.1530/eje-22-0263] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Acromegaly is associated with somatic disfigurements which impair self-perception of well-being and quality of life. Nowadays, limited data are available on the interplay between hormonal excess and psychological discomfort. The study aimed at investigating the psychological profile, sleep quality, sexual function, cognitive functions, and quality of life in patients with acromegaly. METHODS In 223 acromegaly patients from 5 referral centres, global psychological profile, sleep quality, sexual function, cognitive function, and quality of life were investigated. RESULTS Depression was found in ~30% of patients, and anxiety in two-thirds, together with severe discomfort in body image mainly in women. Obstructive sleep apnoea syndrome risk and sleep disorders were found in >50% of patients and daily sleepiness in ~20%. Sexual dysfunction was reported in most of the patients, with the most severe impairment in women. Cognitive functions were compromised in ~10% of cases. Disease duration and patient's age and gender were the main determinants of these psychopathological conditions. Depression (P = 0.047), somatic-affective mood lowering (P = 0.021), state (P < 0.001) and trait (P = 0.013) anxiety, and body image distortion in body uneasiness test A (P < 0.001) and B (P = 0.006) were significantly worsened in patients <45 years and slightly worsened in those with disease duration less than 2 years. Male (P < 0.001) and female (P < 0.001) sexual function scores were significantly worsened in patients aged >64 years and slightly worsened in those with disease duration for more than 10 years, particularly in presence of cardiometabolic and respiratory complications. Cognitive symptoms were slightly worsened in older patients and in those with long disease duration. CONCLUSIONS Acromegaly is associated with a relevant impairment of psychological profile persisting despite remission and long-term medical treatment.
Collapse
Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, ‘Federico II’ University, Naples, Italy
- Correspondence should be addressed to R Pivonello;
| | - Renata Simona Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Alessandra Delli Veneri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Francesca Dassie
- Department of Medicine, Clinica Medica 3^, University of Padua, Padua, Italy
| | - Riccardina Lorusso
- Department of Medicine, Clinica Medica 3^, University of Padua, Padua, Italy
| | - Marta Ragonese
- Endocrine Unit, University Hospital ‘G. Martino’, Messina, Italy
| | - Marco Liotta
- Endocrine Unit, University Hospital ‘G. Martino’, Messina, Italy
| | | | - Barbara Zarino
- Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Lai
- Psychology Unit, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Claudio Urbani
- Endocrinology II Unit, Department of Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Fausto Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanna Mantovani
- Endocrinology Unit
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Pietro Maffei
- Department of Medicine, Clinica Medica 3^, University of Padua, Padua, Italy
| | - Paolo Chiodini
- Medical Statistic Unit, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, ‘Federico II’ University, Naples, Italy
| |
Collapse
|
9
|
Dülger E, Mut M, Erbas T, Sahiner L, Vardar Yağlı N, Bilgin S. Effects of combined aerobic-strength training and yoga on quality of life and related parameters in women with pituitary adenoma after surgery: a randomized crossover study. Eur J Endocrinol 2022; 186:667-675. [PMID: 35380988 DOI: 10.1530/eje-22-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The pituitary gland is responsible for hormonal balance in the body, and disruption of hormonal balance in patients with pituitary adenoma (PA) indirectly affects the quality of life. This study aimed to examine the effects of yoga and combined aerobic and strength training (A+ST) on quality of life and related parameters such as sleep, fatigue, emotional state, sexual function, and cognitive status in women with PA. DESIGN Ten women with PA were included in this randomized crossover study. Group 1 (n = 5, mean age: 52 ± 13.5 years) received A+ST for the first 6 weeks, a 2-week washout period, and yoga for the second 6 weeks. Group 2 (n = 5, mean age: 41.8 ± 14 years) received the yoga program first, followed by the A+ST program. METHODS Participants were assessed using the following tools before and after each exercise intervention: Functional Assessment of Cancer Therapy-Brain (FACT-Br) (quality of life), Pittsburg Sleep Quality Index, Fatigue Severity Scale (FSS), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), and Montreal Cognitive Assessment Scale (MOCA). RESULTS FACT-Br scores were higher after the yoga program, HADS anxiety score was lower after the A+ST program, and MOCA scores increased after both exercise programs (P < 0.05). FSS score decreased after both exercise programs, but not significantly. In addition, nonsignificant decreases in HADS anxiety and depression scores and increased FSFI scores were observed after the yoga program. CONCLUSION A+ST and yoga have positive effects on the quality of life in PA. We recommend yoga and A+ST as a supportive therapy for this population that may face comorbidities after surgical and medical treatment. Our results indicate these patients may benefit from physiotherapist-guided exercise programs.
Collapse
Affiliation(s)
- Esra Dülger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Melike Mut
- Department of Neurosurgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Tomris Erbas
- Department of Endocrinology and Metabolism, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Levent Sahiner
- Department of Cardiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Naciye Vardar Yağlı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sevil Bilgin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
10
|
Muscogiuri G, Zanata I, Barrea L, Cozzolino A, Filice E, Messina E, Colao A, Faggiano A. A practical nutritional guideline to manage neuroendocrine neoplasms through chronotype and sleep. Crit Rev Food Sci Nutr 2022; 63:7546-7563. [PMID: 35285728 DOI: 10.1080/10408398.2022.2047882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Chronotype is the attitude of subjects to carry out their daily activities mainly in the morning ("lark") or in the evening ("owl"). The intermediate chronotype is located between these two categories. It has been demonstrated that chronotype can influence the incidence, course and response to treatments of tumors. In particular patients diagnosed with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) and evening chronotype are characterized by unhealthy lifestyle, obesity, metabolic syndrome, a worsen cardiometabolic profile, a poor prognosis with a progressive disease and the development of metastasis. In addition, evening chronotype has been associated with sleep disturbances, which in turn have been related to tumor development and progression of tumors. There is a strict connection between sleep disturbances and NENs because of the hyperactivation of proangiogenic factors that caused aberrant neoangiogenesis. A nutritional tailored approach could represent a tool to align subjects with evening chronotype to physiological biological rhythms based on the properties of some macro and micronutrients of being substrate for melatonin synthesis. Thus, we aimed to provide an overview on the association of chronotype categories and sleep disturbances with NENs and to provide nutritional advices to manage subjects with NENs and these disturbances of circadian rhythm.
Collapse
Affiliation(s)
- Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile,", Università Federico II di Napoli, Naples, Italy
| | - Isabella Zanata
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Naples, Italy
| | - Alessia Cozzolino
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Emanuele Filice
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Erika Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile,", Università Federico II di Napoli, Naples, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
11
|
Cozzi R, Ambrosio MR, Attanasio R, Battista C, Bozzao A, Caputo M, Ciccarelli E, De Marinis L, De Menis E, Faustini Fustini M, Grimaldi F, Lania A, Lasio G, Logoluso F, Losa M, Maffei P, Milani D, Poggi M, Zini M, Katznelson L, Luger A, Poiana C. Italian Association of Clinical Endocrinologists (AME) and International Chapter of Clinical Endocrinology (ICCE). Position statement for clinical practice: prolactin-secreting tumors. Eur J Endocrinol 2022; 186:P1-P33. [PMID: 35000899 PMCID: PMC8859924 DOI: 10.1530/eje-21-0977] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/06/2022] [Indexed: 12/03/2022]
Abstract
Prolactinomas are the most frequent pituitary adenomas. Prolactinoma may occur in different clinical settings and always require an individually tailored approach. This is the reason why a panel of Italian neuroendocrine experts was charged with the task to provide indications for the diagnostic and therapeutic approaches that can be easily applied in different contexts. The document provides 15 recommendations for diagnosis and 54 recommendations for treatment, issued according to the GRADE system. The level of agreement among panel members was formally evaluated by RAND-UCLA methodology. In the last century, prolactinomas represented the paradigm of pituitary tumors for which the development of highly effective drugs obtained the best results, allowing to avoid neurosurgery in most cases. The impressive improvement of neurosurgical endoscopic techniques allows a far better definition of the tumoral tissue during surgery and the remission of endocrine symptoms in many patients with pituitary tumors. Consequently, this refinement of neurosurgery is changing the therapeutic strategy in prolactinomas, allowing the definitive cure of some patients with permanent discontinuation of medical therapy.
Collapse
Affiliation(s)
- Renato Cozzi
- Division of Endocrinology, Niguarda Hospital, Milan, Italy
- Correspondence should be addressed to R Cozzi;
| | - Maria Rosaria Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Claudia Battista
- Endocrinology Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (FG), Italy
| | - Alessandro Bozzao
- Neuroradiology, S. Andrea Hospital, NESMOS Department (Neuroscience, Mental Health, Sensorial Organs), Sapienza University of Rome, Rome, Italy
| | - Marco Caputo
- Laboratorio Analisi Cliniche e Microbiologia, Synlab SRL, Calenzano, Florence, Italy
| | | | - Laura De Marinis
- Pituitary Unit, Department of Endocrinology, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy
| | | | | | - Franco Grimaldi
- AME President, Endocrinology and Metabolism Unit, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Andrea Lania
- Department of Biomedical Sciences, Endocrinology Unit, Rozzano, Italy
| | - Giovanni Lasio
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | - Marco Losa
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), 3rd Medical Clinic, Padua University Hospital, Padua, Italy
| | - Davide Milani
- Department of Neurosurgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Maurizio Poggi
- Endocrinology, Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Zini
- Endocrinology Unit, Azienda Ospedaliera S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Catalina Poiana
- ‘Carol Davila’ University of Medicine and Pharmacy – Endocrinology, “C.I. Parhon” National Institute of Endocrinology – Pituitary and Neuroendocrine Disorders, Bucharest, Romania
| | | |
Collapse
|
12
|
Wild CM, Stieg M, Stalla GK, Jung-Sievers C, Auer MK, Athanasoulia-Kaspar AP. Sleep patterns in patients treated for non-secreting intra- and parasellar tumors: A self-report case-control study. Front Endocrinol (Lausanne) 2022; 13:1044197. [PMID: 36506041 PMCID: PMC9730232 DOI: 10.3389/fendo.2022.1044197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study we evaluate sleep patterns of patients treated for non-secreting intra- and parasellar tumors and age- and sex-matched healthy controls. METHODS We conducted a self-report cross-sectional case-control study with 104 patients treated for non-secreting intra- and parasellar tumors and 1800 healthy controls in an 1:8 matching. All subjects answered the Munich ChronoType Questionnaire, whereas patients were provided the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Short-Form 36 Health survey, the Beck Depression Inventory and the State-Trait Anxiety Inventory additionally. RESULTS Patients treated for non-secreting intra- and parasellar tumors go to bed earlier, fall asleep earlier, need less time to prepare to sleep but also to get up. Additionally, they lie and sleep longer. The subgroup analysis showed that patients with secondary adrenal insufficiency compared to controls experienced shorter daily light exposure and longer sleep latency. Higher hydrocortisone dose (>20mg) was associated with worse score in global, physical and mental health, shorter time to prepare to sleep, earlier sleep onset and longer sleep duration. CONCLUSION Our study shows that patients treated for non-secreting intra- and parasellar tumors, even if successfully treated, experience altered sleep patterns compared to controls. We suggest that managing clinicians should enlighten these possible sleep alterations to their patients and use specific questionnaires to document sleep disturbances. Additionally, when treating patients surgically, especially by transcranial approach, damaging the suprachiasmatic nucleus should be avoided. Furthermore, circadian hydrocortisone replacement therapy ideally with dual-release hydrocortisone - if possible, in a dose not more than 20mg daily - that resembles physiological cortisol levels more closely may be beneficial and could improve sleep patterns and sleep-related quality of life.
Collapse
Affiliation(s)
- Carl Mathis Wild
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Mareike Stieg
- Medicover Neuroendocrinology, Orleansplatz, Munich, Germany
| | - Günter K. Stalla
- Medicover Neuroendocrinology, Orleansplatz, Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany
| | - Caroline Jung-Sievers
- Chair of Public Health and Health Services Research Institute for Medical Information Processing, Biometry and Epidemiology (IBE) of the Ludwig Maximilian University of Munich, Pettenkofer School of Public Health, Munich, Germany
| | - Matthias K. Auer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anastasia P. Athanasoulia-Kaspar
- Medicover Neuroendocrinology, Orleansplatz, Munich, Germany
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig Maximilian University of Munich, Munich, Germany
- *Correspondence: Anastasia P. Athanasoulia-Kaspar,
| |
Collapse
|
13
|
Zhao X, Heng L, Qu Y, Jia D, Ren J, Sun S, Qiu J, Cheng J, Yang T, Zhou J, Su C. Densely granulated adenoma pattern is associated with an increased risk of obstructive sleep apnea in patients with acromegaly. Sleep Breath 2021; 26:1381-1387. [PMID: 34383277 DOI: 10.1007/s11325-021-02468-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore the prevalence of obstructive sleep apnea (OSA) and the association between the adenoma granulation patterns and OSA in patients with acromegaly. METHODS An overnight polysomnography (PSG) assessment was carried out on participants with acromegaly. Results classified participants into a non-OSA group, mild to moderate OSA group, and severe OSA group. Morphological and biochemical analyses were performed. Demographic, clinical, biochemical, and polysomnographic data were compared among the three groups. Using logistic regression models, the risk of OSA in acromegalic subjects was estimated. RESULTS OSA was reported in 36 of 49 patients (74%) with acromegaly. Contrasted with the non-OSA group, OSA patients had a larger proportion of the densely granulated (DG) pattern. The OSA groups with DG acromegaly had a smaller maximum tumor diameter and Vol/2 than those with the sparsely granulated (SG) pattern. Furthermore, a higher growth hormone (GH) level (45.0 ± 36.9 vs 18.6 ± 15.8, P = 0.047) and GH index (28.4 ± 13.8 vs 6.6 ± 8.2, P = 0.003) were found in DG acromegaly patients with severe OSA. Additionally, there was a trend toward higher standardized insulin-like growth factor 1 (IGF-1) in patients with DG acromegaly than in those with SG acromegaly in the severe OSA group. After adjusting for potential confounding variables, the DG pattern was correlated with the risk of OSA (OR = 14.84, 95%CI 1.36-162.20, P = 0.027) in patients with acromegaly. CONCLUSIONS The findings indicate that a high prevalence of OSA exists in patients with acromegaly, and the DG pattern may be a risk factor for OSA in acromegaly.
Collapse
Affiliation(s)
- Xianchao Zhao
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Lijun Heng
- Department of Neurosurgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, China
| | - Dong Jia
- Department of Neurosurgery, Tangdu Hospital of the Fourth Military Medical University, Xi'an, China
| | - Jiafeng Ren
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Shuyu Sun
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Jian Qiu
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Jinxiang Cheng
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Ting Yang
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China
| | - Junying Zhou
- Sleep Medicine Center, West China Hospital of Sichuan University, Dian Xin Nan Jie 28#, Chengdu, 610041, China. .,Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Changjun Su
- Sleep Medicine Center, Tangdu Hospital of the Fourth Military Medical University, Xinsi Road 569#, Xi'an, 710038, China.
| |
Collapse
|
14
|
Lin MR, Chen PY, Wang HC, Lin PC, Lee HC, Chiu HY. Prevalence of sleep disturbances and their effects on quality of life in adults with untreated pituitary tumor and meningioma. J Neurooncol 2021; 154:179-186. [PMID: 34304334 DOI: 10.1007/s11060-021-03811-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the prevalence of sleep disturbances and their effects on quality of life in adults with pituitary tumor or meningioma. METHODS This prospective study included 33 and 44 patients with pituitary tumor and meningioma, respectively. All participants completed a series of valid questionnaires for assessing sleep and quality of life; all participants wore 3-day actigraph prior to related treatment. The actigraph-derived sleep parameters included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and dichotomy index (I < O) value. RESULTS The prevalence of insomnia, excessive daytime sleepiness, and poor sleep quality was 46.8%, 6.5%, and 81.8%, respectively. The differences in these sleep parameters between patients with pituitary tumor and those with meningioma were nonsignificant. Only 27 participants completed the actigraphic assessments. The mean I < O value was 95.99%, and nearly 60% participants exhibited circadian rhythm disruption. Sleep quality was the only sleep variable independently correlated with preoperative quality of life, even after adjustments for confounders (B = 0.80, p = 0.02). CONCLUSIONS Insomnia, poor sleep quality, and disrupted circadian rhythm are highly prevalent in adults with untreated pituitary tumor or meningioma. Sleep quality independently correlated with quality of life. We indirectly confirmed that tumor location may not be a possible cause of sleep changes.
Collapse
Affiliation(s)
- Mei-Ru Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery and Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
15
|
Sagan KP, Andrysiak-Mamos E, Tyburski E, Sagan LM, Syrenicz A. Quality of Life and Sleep in Patients with Pituitary Adenoma in Relation to Tumor Type and Compression of the Optic Chiasm. J Clin Med 2021; 10:jcm10091879. [PMID: 33926090 PMCID: PMC8123647 DOI: 10.3390/jcm10091879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the effect of transsphenoidal surgery on quality of life and sleep in patients with pituitary adenomas depending on tumor type and compression of the optic chiasm. Methods: In this prospective study, patients with pituitary adenomas who were scheduled for transsphenoidal surgery completed the Short Form 36 Questionnaire, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale preoperatively and 7.5 (±1.5) months after surgery. Patients were analyzed based on tumor type and compression of the optic chiasm. Results: Significant improvements with large effect sizes were seen for patients with Cushing’s disease in general health (Z = −2.37; p = 0.018), vitality (Z = −2.05; p = 0.041), and mental health (Z = −2.06; p = 0.040). A significant deterioration with large effect size occurred in physical functioning (Z = −2.02; p = 0.043) in patients with acromegaly. A significant improvement with medium effect size was seen in subjective sleep quality, (Z = −2.24; p = 0.025), sleep duration (Z = −2.11; p = 0.035), and habitual sleep efficiency (Z = −2.26; p = 0.024) after decompression of the optic chiasm. Multiple significant correlations were observed between sleep parameters and Short Form 36 subscales before and after treatment. Conclusions: Changes in quality of life during the follow-up period depend on tumor type. Circadian rhythm disturbances may resolve promptly after decompression of the optic chiasm. Quality of life in pituitary adenoma patients is associated with quality of sleep in many dimensions, thus implying that developing strategies to improve sleep quality could increase overall well-being and everyday functioning in pituitary adenoma patients.
Collapse
Affiliation(s)
- Karol Piotr Sagan
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
- Correspondence: ; Tel.: +48-91-425-3540
| | - Elżbieta Andrysiak-Mamos
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
| | - Ernest Tyburski
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Poznan, Poland;
| | - Leszek Michał Sagan
- Department of Neurosurgery, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Anhelli Syrenicz
- Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.A.-M.); (A.S.)
| |
Collapse
|
16
|
Jeon MS, Agar MR, Koh ES, Nowak AK, Hovey EJ, Dhillon HM. Barriers to managing sleep disturbance in people with malignant brain tumours and their caregivers: a qualitative analysis of healthcare professionals' perception. Support Care Cancer 2021; 29:3865-3876. [PMID: 33386987 DOI: 10.1007/s00520-020-05970-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explores healthcare professionals (HCPs)' perception and current management of sleep disturbance (SD) in people with malignant brain tumours and their caregivers. We aimed to identify barriers to effective management of SD in neuro-oncology care. METHODS We conducted semi-structured interviews with 11 HCPs involved in neuro-oncology care. The study was underpinned by the Capability Opportunity Motivation-Behaviour (COM-B) model within the Behavioural Change Wheel (BCW) guiding topic selection for the exploration of underlying processes of HCPs' behaviours and care decisions for SD management. Data were analysed thematically using a framework synthesis, and subsequently mapped onto the BCW to identify barriers for effective management and recommend potential interventions. RESULTS We identified four themes: HCPs' clinical opinions about SD, the current practice of SD management in neuro-oncology clinics, gaps in the current practice, and suggested areas for improvements. HCPs perceived SD as a prevalent yet secondary issue of low priority in neuro-oncology care. SD was unrecognised, and inadequately managed in usual clinical settings. Interventional options included modifying the use of corticosteroids or prescribing sedatives. When mapped onto the BCW, themes identified main barriers as a lack of awareness among HCPs about SD warranting care, due to the absence of screening tools and limited knowledge and resources for therapeutic interventions. CONCLUSIONS Multidisciplinary HCPs need training in the routine use of appropriate sleep assessment tools, and access to clear management pathways. More professional resources are needed to educate staff in implementing appropriate interventions for people with malignant brain tumours who are experiencing SD.
Collapse
Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia.
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, Australia
| | - Elizabeth J Hovey
- University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia
| |
Collapse
|
17
|
Kim SH, Kim N, Min KT, Kim EH, Oh H, Choi SH. Sleep disturbance and delirium in patients with acromegaly in the early postoperative period after transsphenoidal pituitary surgery. Medicine (Baltimore) 2020; 99:e23157. [PMID: 33158000 PMCID: PMC7647521 DOI: 10.1097/md.0000000000023157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sleep disturbance is a common comorbidity among patients with acromegaly [patients with growth hormone (GH)-secreting tumor] due to somatotropic axis change and sleep apnea. However, no previous studies exist concerning sleep disturbance and delirium in the early postoperative period in patients with acromegaly undergoing transsphenoidal tumor surgery. Herein, we aimed to compare the incidence of postoperative sleep disturbance and delirium in the early postoperative period between patients with GH-secreting and nonfunctioning pituitary tumors.We retrospectively reviewed the medical records of 1286 patients (969 with nonfunctioning and 317 with GH-secreting tumors) without history of psychological disease and sedative or antipsychotic use. We examined the use of antipsychotics/sedatives and findings of psychology consultation within the first postoperative week. Only patients with sleep disturbance noted in medical records were considered to have postoperative sleep disturbance. Patients with an Intensive Care Delirium Screening Checklist score of 4 or more were considered to have postoperative delirium.The incidence of postoperative sleep disturbance was higher in the GH-secreting group than in the nonfunctioning tumor group (2/969 [0.2%] vs 6/317 [1.9%]; P = .004; odds ratio = 9.328 [95% confidence interval, 1.873-46.452]). Univariable regression analysis showed that only diagnosis (GH-secreting tumor or nonfunctioning tumor) was a risk factor for sleep disturbance, and not sex, age, body mass index, American Society of Anesthesiologists physical status score, surgery duration, anesthesia duration, anesthesia type, tumor size, cavernous sinus invasion, or bleeding. The incidence of postoperative delirium was comparable between the 2 groups (6/969 [0.6%] vs 0/317 [0%]; P = .346).Patients with acromegaly showed increased incidence of sleep disturbance than those with nonfunctioning tumors in the early postoperative period after transsphenoidal tumor surgery. A prospective study evaluating sleep quality in patients with GH-secreting tumors in the early postoperative period could be conducted based on our findings.
Collapse
Affiliation(s)
| | - Namo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Kyeong Tae Min
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| | - Eui Hyun Kim
- Department of Neurosurgery, Pituitary Tumor Center, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, Republic of Korea
| | - Hanseul Oh
- Department of Anesthesiology and Pain Medicine
| | - Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute
| |
Collapse
|
18
|
Silvaggi F, Leonardi M, Raggi A, Eigenmann M, Mariniello A, Silvani A, Lamperti E, Schiavolin S. Employment and Work Ability of Persons With Brain Tumors: A Systematic Review. Front Hum Neurosci 2020; 14:571191. [PMID: 33192403 PMCID: PMC7658191 DOI: 10.3389/fnhum.2020.571191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/28/2020] [Indexed: 01/21/2023] Open
Abstract
Brain tumors (BT) are between the eight most common cancers among persons aged 40 years, with an average survival time of 10 years for patients affected by non-malignant brain tumor. Some patients continue to work, reporting difficulties in work-related activities, or even job loss. The purpose of the present study was to review the existing information about the ability people with BT to return to work and to identify factors associated with job loss. We performed a systematic review on SCOPUS and EMBASE for peer-reviewed papers that reported studies assessing work ability in patients with BT that were published in the period from January 2010 to January 2020. Out of 800 identified records, 7 articles were selected for analysis, in which 1,507 participants with BT were enrolled overall. Three main themes emerged: the impact of neuropsychological functioning on work productivity, the change of employment status for long-term survivors and issues related to return to work processes. Based on the results of selected studies, it can be concluded that the impact of BT on workforce participation is determined by depressive symptoms and cognitive deficits, as well as by high short-term mortality but also on environmental barriers. Vocational Rehabilitation programs should be implemented to help patients wishing to return to or maintain their current work, as much as possible.
Collapse
Affiliation(s)
- Fabiola Silvaggi
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michela Eigenmann
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Mariniello
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Silvani
- Unità Operativa Complessa Neurologia 2 – Neuro-Oncologia Clinica, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Lamperti
- Unità Operativa Complessa Neurologia 2 – Neuro-Oncologia Clinica, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Silvia Schiavolin
- Unità Operativa Complessa Neurologia, Salute Pubblica, Disabilità, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
19
|
Wild CM, Stieg M, Stalla GK, Auer MK, Athanasoulia-Kaspar AP. Health-related quality of life in patients with non-functioning pituitary adenoma: a special focus on hydrocortisone replacement dose. Qual Life Res 2020; 29:3325-3331. [PMID: 32737686 DOI: 10.1007/s11136-020-02582-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with non-functioning pituitary adenomas (NFPA) suffer from pronounced impairments in physical and mental measures that result in an impairment of health-related quality of life (HRQOL). The role of secondary adrenal insufficiency (SAI) and especially the one of the hydrocortisone (HC) replacement dose on the HRQOL seems to be conflicting. The primary aim of this study is to assess the HRQOL in patients with NFPA in terms of presence of SAI and in patients without SAI and the secondary to explore the impact of treatment parameters such as daily HC dose. DESIGN/METHODS In a cross-sectional study we evaluated parameters of HRQOL in 95 patients with NFPA of the Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry in Munich using standardized questionnaires like Short Form (SF-36), Beck's Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and a self-constructed questionnaire about medical history. RESULTS We could not find any significant difference between patients with and without SAI in the standardized questionnaires in terms of HRQOL. We could show that higher doses of HC were negatively correlated with HRQOL measured by SF-36 global health score regardless of using BDI or STAI in the block (β = - 0.397; p = 0.021, β = - 0.390; p = 0.016, respectively). CONCLUSIONS NFPA patients with SAI do not have a worse HRQOL than patients with NFPA and intact corticotropic axis. We could show that higher doses of HC are associated with an impaired HRQOL measured by SF-36 global and physical health score, whereas mental health score is not significantly influenced by the HC dose.
Collapse
Affiliation(s)
- Carl Mathis Wild
- Gynecology and Obstetrics, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Mareike Stieg
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Günter K Stalla
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany.,Medicover Neuroendocrinology, Orleansplatz 3, 81667, Munich, Germany
| | - Matthias K Auer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | | |
Collapse
|
20
|
Sleep quality in acromegaly and changes after transsphenoidal surgery: a prospective longitudinal study. Sleep Med 2020; 67:164-170. [PMID: 31935618 DOI: 10.1016/j.sleep.2019.11.1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To elucidate the sleep quality characteristics and factors related to either good or poor sleep quality in acromegaly patients before surgery and to explore sleep quality changes after transsphenoidal surgery and the factors related to these changes. METHODS We prospectively enrolled 39 acromegaly patients and 78 patients with nonfunctioning pituitary adenomas. Scales for anxiety, depression, disease stigma and nasal condition were evaluated. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered before surgery as well as one month and three months after surgery. RESULTS A higher percentage of acromegaly patients had poor sleep quality compared to controls (35.9% vs. 5.1%, p < 0.001). In addition, acromegaly patients experienced worse subjective sleep quality, extended sleep latency, increased sleep disturbance and decreased daytime functioning. Higher scores for anxiety, disease stigma and sinonasal outcomes were correlated with worse sleep quality in acromegaly patients. At one month after transsphenoidal surgery, we found worse subjective sleep quality, extended sleep latency, shortened sleep duration, impaired sleep efficiency and increased sleep disturbance in acromegaly patients. At three months postoperatively, most impaired PSQI domains in acromegaly patients recovered to preoperative levels. The use of soluble gauze was related to decreased sleep quality at one month after surgery and severe anxiety and depression were related to improved sleep quality at three months after surgery. CONCLUSIONS Sleep quality was reduced in acromegaly patients. Moreover, sleep quality initially worsened after surgery but later recovered. Emotional problems and the use of soluble gauze were related factors. CLINICAL TRIAL REGISTRATION None.
Collapse
|
21
|
Abstract
BACKGROUND The delayed diagnosis, altered body image, and clinical complications associated with acromegaly impair quality of life. PURPOSE To assess the efficacy of the cognitive-behavioral therapy (CBT) technique "Think Healthy" to increase the quality of life of patients with acromegaly. METHODS This non-randomized clinical trial examined ten patients with acromegaly (nine women and one man; mean age, 55.5 ± 8.4 years) from a convenience sample who received CBT. The intervention included nine weekly group therapy sessions. The quality of life questionnaire the 36-Item Short Form Survey (SF-36) and the Beck Depression Inventory (BDI) were administered during the pre- and post-intervention phases. The Wilcoxon signed-rank test was performed to assess the occurrence of significant differences. RESULTS According to the SF-36, the general health domain significantly improved (d' = - 0.264; p = 0.031). The mental health domain improved considerably (d' = - 1.123; p = 0.012). Physical functioning showed a non-significant trend toward improvement (d' = - 0.802; p = 0.078), although four of the five patients who showed floor effects improved and remained at this level. Regarding emotional well-being, five patients showed floor effects and four improved, and the condition did not change among any of the four patients who showed ceiling effects. No significant changes were found with regard to the other domains. No significant differences in the BDI were found before or after the intervention. CONCLUSION The technique presented herein effectively improved the quality of life of patients with acromegaly with different levels of disease activity, type, and treatment time.
Collapse
Affiliation(s)
- Lia Silvia Kunzler
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil.
| | - Luciana Ansaneli Naves
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
| | - Luiz Augusto Casulari
- SRTVS 701, Edifício Centro Empresarial Brasília, Bloco "C", sala 204, Asa Sul, Brasília, DF, CEP: 70.340-907, Brazil
| |
Collapse
|
22
|
Jeon MS, Dhillon HM, Agar MR. Sleep disturbance of adults with a brain tumor and their family caregivers: a systematic review. Neuro Oncol 2018; 19:1035-1046. [PMID: 28340256 DOI: 10.1093/neuonc/nox019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The high incidence and psychophysiological morbidities of sleep disturbance in cancer have been increasingly recognized. Yet, more detailed understanding of sleep disturbance and options for management have been neglected areas in both clinical care and research. Brain tumor patients have been particularly overlooked. A systematic search of the literature from 1990 to 2015 was performed to review sleep disturbance in adults with primary or secondary brain tumor and their family caregivers. Fifty eligible studies were identified, of which 12 focused on sleep, 37 reported sleep items within a health-related quality of life measure and 1 reported caregivers' sleep. No sleep intervention has been developed or tested for brain tumor patients. Sleep disturbance and somnolence were frequently reported as the most severely rated symptoms within health-related quality of life across the disease course or treatments, along with fatigue. However, sleep-focused studies yielded inconsistent results in small samples of mostly benign brain tumors in long-term remission from total tumor resection. The research using standardized, multifaceted sleep assessments, particularly in patients with malignant brain tumor and caregivers who are undergoing treatment, is seriously lacking. A more systematic examination of sleep disturbance is warranted to inform the development of better symptom management programs in this population.
Collapse
Affiliation(s)
- Megan Soohwa Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Haryana M Dhillon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| |
Collapse
|
23
|
Huang J, Zeng C, Xiao J, Zhao D, Tang H, Wu H, Chen J. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget 2017; 8:94932-94943. [PMID: 29212279 PMCID: PMC5706925 DOI: 10.18632/oncotarget.19843] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with brain tumor are in risk of depression or depressive symptoms, but the estimated prevalence varies between studies. The aim of this study is to get a proper summarized estimate of depression prevalence in brain tumor patients. METHODS Literature search on Pubmed, PsycINFO, and Cochrane library from January 1981 through October 2016. The prevalence of depression or depressive symptoms in brain tumor patients was estimated by screening scales and analyzed using stratified meta-analysis and subgroup analysis. The prevalence of depression level or symptoms during the follow-up periods was detected by secondary analysis. RESULTS Among the 37 studies included in this meta-analysis, 25 used a cross-sectional design and 12 used longitudinal study. The pooled prevalence was 21.7% (971/4518 individuals, 95 % confidence interval (CI) 18.2%-25.2%) for overall sample. Lower prevalence was detected in studies with sample size ≥100 than <100, lower grade tumor than high grade tumor, studies using clinician-rated depression scales than self-rated or non-depression-specific ones, and in patients from UK, Germany and Italy than USA. After analyzing 6 longitudinal studies, prevalence of depression remained no change in the follow-up periods. No significant differences were observed between study designs and tumor types. CONCLUSIONS The estimated prevalence of depression or depressive symptoms among brain tumor patients was 21.7%, affected by depression assessment type, sample size, tumor grade and country. Diagnosis and treatment of co-morbid depression in brain tumor patients need to be addressed in future studies for better life quality and oncology management.
Collapse
Affiliation(s)
- Jing Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Chao Zeng
- Department of Thoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Juxiong Xiao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danwei Zhao
- Xiangya Medical School, Central South University, Changsha, Hunan, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| |
Collapse
|
24
|
Webb SM, Crespo I, Santos A, Resmini E, Aulinas A, Valassi E. MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease. Eur J Endocrinol 2017; 177:R13-R26. [PMID: 28351913 DOI: 10.1530/eje-17-0041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. OBJECTIVE To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. DESIGN Critical review of the pertinent literature and pragmatic discussion of available information. METHODS Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis. RESULTS QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing's disease (similar to other causes of Cushing's syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine 'cure', scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated. CONCLUSIONS To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.
Collapse
Affiliation(s)
- Susan M Webb
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Iris Crespo
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Alicia Santos
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eugenia Resmini
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Aulinas
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Valassi
- Hospital Sant PauIIB-Sant Pau, Research Center for Pituitary Diseases, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), ISCIII, and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
25
|
The impact on cognitive functions of patients with pituitary adenoma before and after surgery. Neurol Sci 2017; 38:1315-1321. [DOI: 10.1007/s10072-017-2980-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/26/2017] [Indexed: 12/19/2022]
|
26
|
Auer MK, Liedl A, Fuss J, Nieder T, Briken P, Stalla GK, Hildebrandt T, Biedermann SV, Sievers C. High impact of sleeping problems on quality of life in transgender individuals: A cross-sectional multicenter study. PLoS One 2017; 12:e0171640. [PMID: 28199359 PMCID: PMC5310898 DOI: 10.1371/journal.pone.0171640] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/25/2017] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Studies in the general population suggest that determinants of QoL are often sex-dependent. Sex-dependent analyses of QoL in transgender populations have not been performed so far. AIM To identify sex-specific and potentially modifiable determinants of QoL in transgender patients. METHODS In this cross-sectional multicentre study including 82 transwomen (TW) and 72 transmen (TM) at different treatment stages, we investigated potential determinants for QoL focusing on the impact of mood (BDI, STAI-X), sleep quality (PSQI), chronic pain (GPQ), body image (FBeK) and social support (SSS). MAIN OUTCOME MEASURE Health-related quality of life measured with the Short Form (36) Health Survey (SF-36). RESULTS The age-adjusted SF-36 total score and its subscales did not significantly differ between TM and TW. Using a multivariate regression analysis approach, we identified common but also sex-dependent determinants for QoL (Adjusted R2 = 0.228; 0.650 respectively). Accounting for general characteristics such as age, BMI and treatment status, sleep quality according to the PSQI was an independent and strong determinant of QoL in both sexes (β = -0.451, p = 0.003 TM; β = -0.320; p = 0.0029 TW). Chronic pain was a significant independent predictor of QoL in TM (β = -0.298; p = 0.042) but not in TW. In contrast, anxiety (β = -0.451; p< 0.001) being unemployed (β = -0.206; p = 0.020) and insecurity about the own appearance (FBeK) (β = -0.261; p = 0.01) were independent predictors of QoL in TW. The rate of those reporting high sleep disturbances (PSQI ≥5) was high with 79.2% in TW and 81.2% in TM. Accordingly, age-adjusted QoL was also significantly lower in those reporting poor sleep in both sexes. CONCLUSIONS Sleep strongly affected QoL in both genders, while other factors, like pain and body image, seem to be gender specific in transgender individuals.
Collapse
Affiliation(s)
- Matthias K. Auer
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Anita Liedl
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Fuss
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo Nieder
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Günter K. Stalla
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Sarah V. Biedermann
- Clinic of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Caroline Sievers
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| |
Collapse
|
27
|
Choueiry N, Salamoun T, Jabbour H, El Osta N, Hajj A, Rabbaa Khabbaz L. Insomnia and Relationship with Anxiety in University Students: A Cross-Sectional Designed Study. PLoS One 2016; 11:e0149643. [PMID: 26900686 PMCID: PMC4762701 DOI: 10.1371/journal.pone.0149643] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/03/2016] [Indexed: 12/12/2022] Open
Abstract
Purpose Sleep disorders (SDs) are now recognized as a public health concern with considerable psychiatric and societal consequences specifically on the academic life of students. The aims of this study were to assess SDs in a group of university students in Lebanon and to examine the relationship between SDs and anxiety. Methods An observational cross-sectional study was conducted at Saint-Joseph University, Lebanon, during the academic year 2013–2014. Four questionnaires were face-to-face administered to 462 students after obtaining their written consent: Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Generalized Anxiety Disorder 7-item scale (GAD-7). Results The prevalence of clinically significant insomnia was 10.6% (95% CI: 7.8–13.4%), more frequent in first year students. ISI mean score was 10.06 (SD = 3.76). 37.1% of the participants were poor sleepers. Excessive daytime sleepiness (EDS) and poor sleep were significantly more frequent among participants with clinical insomnia (p = 0.031 and 0.001 respectively). Clinically significant anxiety was more frequent in students suffering from clinical insomnia (p = 0.006) and in poor sleepers (p = 0.003). 50.8% of the participants with clinically significant anxiety presented EDS versus 30.9% of those with no clinically significant anxiety (p<0.0001). Conclusions The magnitude of SDs in this sample of Lebanese university students demonstrate the importance of examining sleep health in this population. Moreover, the link between SD and anxiety reminds us of the importance of treating anxiety as soon as detected and not simply targeting the reduction of sleep problems.
Collapse
Affiliation(s)
- Nour Choueiry
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Tracy Salamoun
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Hicham Jabbour
- Department of Anesthesia and Critical Care, Hôtel-Dieu de France Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
- Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Nada El Osta
- Department of Public Health, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Department of Prosthodontics, Faculty of Dental Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
- Laboratoire de Pharmacologie, Pharmacie clinique et Contrôle de qualité des médicaments, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lydia Rabbaa Khabbaz
- Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
- Laboratoire de Pharmacologie, Pharmacie clinique et Contrôle de qualité des médicaments, Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon
- * E-mail:
| |
Collapse
|