Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission
Abstract
CONTEXT: Cushing's syndrome (CS) is associated with symptoms that may impair health-related quality of life (HRQL). METHODS: We used the short-form 36 survey to evaluate HRQL in 23 patients with Cushing's disease before and after transsphenoidal surgery (age, 42.7 +/- 12.0 yr; 19 women and four men) and in a cross-section of 343 CS patients (age, 48.2 +/- 14.1 yr; 265 women and 78 men) in remission for up to 25.8 yr after surgery (adrenal, 5%; ectopic, 6%). The z-scores were calculated for short-form 36 domains, and physical (PCS) and mental (MCS) summary scores were compared with those of age- and sex-matched controls (n = 6742). RESULTS: Active Cushing's disease was associated with low PCS and MCS scores (P < 0.05). Despite residual postoperative impairment, primarily of physical domains, all HRQL parameters improved after treatment with transsphenoidal surgery (3.2 +/- 1.5 yr; P < 0.05). In the cross-section in remission at follow-up, there was a small, but significant (P < 0.05), impairment of both PCS and MCS. A longitudinal postoperative analysis confirmed stable, but impaired, HRQL over time. Logistic regression demonstrated that previous pituitary radiation and current glucocorticoid use had little effect on HRQL outcomes. CONCLUSION: CS is associated with impaired HRQL, which partially resolves after treatment. At longer-term follow-up, however, there is residual impairment of HRQL. Determination of modifiable factors that contribute to impaired HRQL may help reduce the physical and psychosocial burden of this disease.
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Among patients with CS, normalization of cortisol concentrations results in improvements in morbidity, mortality, and quality of life.
“Among patients with CS, normalization of cortisol concentrations results in improvements in morbidity, mortality, and quality of life (28, 35, 109, 110).”
From Measuring cortisol in Cushing syndrome: diagnosis, monitoring, and cortisol circadian rhythm improvement. (2026) · cites this paper as [109]
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- Authors
- Lindsay, J. R., Nansel, T., Baid, S., Gumowski, J., & Nieman, L. K.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Nieman, Lynnette K.
- ORCID
- Nieman, Lynnette K.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2006-02
- Volume
- 91
- Issue
- 2
- Pages
- 447-453
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2149619533
- Cited by
- 210
- References
- 24
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 3 · 2023: 6 · 2022: 14 · 2021: 9 · 2020: 4 · 2019: 8 · 2018: 12 · 2017: 9 · 2016: 13 · 2015: 22 · 2014: 14 · 2013: 16 · 2012: 20
- FWCI
- 6.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Keywords
- Cushing's syndrome, Cushing's disease, health-related quality of life, transsphenoidal surgery, surgical remission, long-term outcomes, physical function, mental health, glucocorticoid use, residual impairment
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Cushing Syndrome, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Remission Induction, Cohort Studies
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