Background: The primary object was to investigate whether the Tuebingen CD-25 captures changes in health-related quality of life (HRQoL) sensitively in Cushing's disease (CD) and to identify factors that favour postoperative HRQoL. Methods: 17 CD patients were scheduled for transsphenoidal tumour removal and filled out the inventory before and after surgery. The mean time elapsed after surgery was 14.4 ± 11.3 months. All patients were in remission at the second timepoint of investigation. Results: HRQoL as assessed with the Tuebingen CD-25 improved significantly after successful surgical tumour removal. A large effect size (Cohen's d = 0.84) in the total score indicates good sensitivity to change. 13 patients (76.5%) showed impaired HRQoL preoperatively compared with a general population sample. Postoperatively, 35.3% of the patients still suffered from an impaired HRQoL. Stepwise linear regression analysis revealed that less comorbidities (≤2) and greater morning cortisol decrease were promotive factors for better postoperative HRQoL (p < 0.05). The postoperative improvement in HRQoL could be best predicted by the presence of preoperative HRQoL impairment and age of the patients, i.e. patients who were younger were more likely to improve. Moreover, patients without postoperative pituitary deficiencies improved significantly more in the cognition scale. A tendency towards more improvement in overall HRQoL was observed in non-hypocortisolaemic patients. Conclusions: The Tuebingen CD-25 has proved to be a capable and sensitive instrument to investigate HRQoL in the course of disease. The number of postoperative comorbidities had the greatest impact on postoperative well-being.

Keywords:
Tuebingen CD-25, Cushing’s disease, Prospective study, Health-related quality of life, Depression, Responder rate, Remission
1.
Johnson MD, Woodburn CJ, Vance ML: Quality of life in patients with a pituitary adenoma. Pituitary 2003;6:81-87.
2.
Pivonello R, De Martino MC, De Leo M, Tauchmanovà L, Faggiano A, Lombardi G, Colao A: Cushing's syndrome: aftermath of the cure. Arq Bras Endocrinol Metabol 2007;51:1381-1391.
3.
Colao A, Pivonello R, Spiezia S, Faggiano A, Ferone D, Filippella M, Marzullo P, Cerbone G, Siciliani M, Lombardi G: Persistence of increased cardiovascular risk in patients with Cushing's disease after five years of successful cure. J Clin Endocrinol Metab 1999;84:2664-2672.
4.
Colao A, Cozzolino A, Pivonello R: Quality of life in patients with Cushing's disease: a modern approach. Clin Endocrinol (Oxf) 2012;76:776-777.
5.
Sonino N, Fava GA, Raffi AR, Boscaro M, Fallo F: Clinical correlates of major depression in Cushing's disease. Psychopathology 1998;31:302-306.
6.
Loosen PT, Chambliss B, DeBold CR, Shelton R, Orth DN: Psychiatric phenomenology in Cushing's disease. Pharmacopsychiatry 1992;25:192-198.
7.
Kelly WF, Kelly MJ, Faragher B: A prospective study of psychiatric and psychological aspects of Cushing's syndrome. Clin Endocrinol (Oxf) 1996;45:715-720.
8.
Starkman MN, Schteingart DE: Neuropsychiatric manifestations of patients with Cushing's syndrome. Relationship to cortisol and adrenocorticotropic hormone levels. Arch Intern Med 1981;141:215-219.
9.
Webb SM, Badia X, Barahona MJ, Colao A, Strasburger CJ, Tabarin A, van Aken MO, Pivonello R, Stalla G, Lamberts SW, Glusman JE: Evaluation of health-related quality of life in patients with Cushing's syndrome with a new questionnaire. Eur J Endocrinol 2008;158:623-630.
10.
Starkman MN, Giordani B, Berent S, Schork MA, Schteingart DE: Elevated cortisol levels in Cushing's disease are associated with cognitive decrements. Psychosom Med 2001;63:985-993.
11.
Psaras T, Milian M, Hattermann V, Freiman T, Gallwitz B, Honegger J: Demographic factors and the presence of comorbidities do not promote early detection of Cushing's disease and acromegaly. Exp Clin Endocrinol Diabetes 2011;119:21-25.
12.
Lindsay JR, Nansel T, Baid S, Gumowski J, Nieman LK: Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission. J Clin Endocrinol Metab 2006;91:447-453.
13.
Heald AH, Ghosh S, Bray S, Gibson C, Anderson SG, Buckler H, Fowler HL: Long-term negative impact on quality of life in patients with successfully treated Cushing's disease. Clin Endocrinol (Oxf) 2004;61:458-465.
14.
Dorn LD, Burgess ES, Friedman TC, Dubbert B, Gold PW, Chrousos GP: The longitudinal course of psychopathology in Cushing's syndrome after correction of hypercortisolism. J Clin Endocrinol Metab 1997;82:912-919.
15.
Tiemensma J, Biermasz NR, Middelkoop HA, van der Mast RC, Romijn JA, Pereira AM: Increased prevalence of psychopathology and maladaptive personality traits after long-term cure of Cushing's disease. J Clin Endocrinol Metab 2010;95:E129-E141.
16.
Santos A, Resmini E, Martínez-Momblán MA, Crespo I, Valassi E, Roset M, Badia X, Webb SM: Psychometric performance of the CushingQoL questionnaire in conditions of real clinical practice. Eur J Endocrinol 2012;167:337-342.
17.
Milian M, Teufel P, Honegger J, Gallwitz B, Schnauder G, Psaras T: The development of the Tuebingen Cushing's disease quality of life inventory (Tuebingen CD-25). Part I: Construction and psychometric properties. Clin Endocrinol (Oxf) 2012;76:851-860.
18.
Milian M, Teufel P, Honegger J, Gallwitz B, Schnauder G, Psaras T: The development of the Tuebingen Cushing's disease quality of life inventory (Tuebingen CD-25). Part II: Normative data from 1,784 healthy people. Clin Endocrinol (Oxf) 2012;76:861-867.
19.
Biller BM, Grossman AB, Stewart PM, Melmed S, Bertagna X, Bertherat J, Buchfelder M, Colao A, Hermus AR, Hofland LJ, Klibanski A, Lacroix A, Lindsay JR, Newell-Price J, Nieman LK, Petersenn S, Sonino N, Stalla GK, Swearingen B, Vance ML, Wass JA, Boscaro M: Treatment of adrenocorticotropin-dependent Cushing's syndrome: a consensus statement. J Clin Endocrinol Metabol 2008;93:2454-2462.
20.
Angermeyer MC, Kilian R, Matschinger H: WHOQOL-100 und WHOQOL-BREF - Handbuch für die deutschsprachige Version der WHO Instrumente zur Erfassung von Lebensqualität. Göttingen, Hogrefe, 2000.
21.
Norman GR, Sloan JA, Wyrwich KW: Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003;41:582-592.
22.
Psaras T, Milian M, Hattermann V, Will BE, Tatagiba M, Honegger J: Predictive factors for neurocognitive function and quality of life after surgical treatment for Cushing's disease and acromegaly. J Endocrinol Invest 2011;34:168-177.
23.
Honegger J, Schmalisch K, Beuschlein F, Kaufmann S, Schnauder G, Naegele T, Psaras T: Contemporary microsurgical concept for the treatment of Cushing's disease: endocrine outcome in 83 consecutive patients. Clin Endocrinol (Oxf) 2012;76:560-567.
24.
Sonino N, Fava GA, Raffi AR, Boscaro M, Fallo F: Clinical correlates of major depression in Cushing's disease. Psychopathology 1998;31:302-306.
25.
Pikkarainen L, Sane T, Reunanen A: The survival and well-being of patients treated for Cushing's syndrome. J Intern Med 1999;245:463-468.
26.
Forget H, Lacroix A, Cohen H: Persistent cognitive impairment following surgical treatment of Cushing's syndrome. Psychoneuroendocrinology 2002;27:367-383.
27.
Heald A, Parr C, Gibson C, O'driscoll K, Fowler H: A cross-sectional study to investigate long-term cognitive function in people with treated pituitary Cushing's disease. Exp Clin Endocrinol Diabetes 2006;114:490-497.
28.
Hook JN, Giordani B, Schteingart DE, Guire K, Giles J, Ryan K, Gebarski SS, Langenecker SA, Starkman MN: Patterns of cognitive change over time and relationship to age following successful treatment of Cushing's disease. J Int Neuropsychol Soc 2007;13:21-29.
29.
Milian M, Honegger J, Gerlach C, Psaras T: Health-related quality of life and psychiatric symptoms improve effectively within a short time in patients surgically treated for pituitary tumors - a longitudinal study of 106 patients. Acta Neurochir 2013;155:1637-1645.
30.
Van Aken MO, Pereira AM, Biermasz NR, van Thiel SW, Hoftijzer HC, Smit JW, Roelfsema F, Lamberts SW, Romijn JA: Quality of life in patients after long-term biochemical cure of Cushing's disease. J Clin Endocrinol Metabol 2005;90:3279-3286.
31.
Sippel RS, Elaraj DM, Kebebew E, Lindsay S, Tyrrell JB, Duh QY: Waiting for change: symptom resolution after adrenalectomy for Cushing's syndrome. Surgery 2008;144:1054-1061.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.