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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 (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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Cited by
Sorted by citations
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
Nieman, L. K., Biller, B. M. K., Findling, J. W., Newell-Price, J., Savage, M. O., Stewart, P. M., & Montori, V. M. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0125 · Cited by 2,718
“Additionally, quality of life improves after surgical treatment but remains below that of age- and gendermatched subjects for up to 15 yr (18).”
BackgroundSelf-citationTreatment of Cushing's syndrome: an Endocrine Society clinical practice guideline
Nieman, L. K., Biller, B. M. K., Findling, J. W., Murad, M. H., Newell-Price, J., Savage, M. O., & Tabarin, A. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-1818 · Cited by 1,270
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Metadata
- 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 › Oncology › 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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