Exp Clin Endocrinol Diabetes 2014; 122 - P047
DOI: 10.1055/s-0034-1372064

What causes long-lasting psychosocial impairment in patients with Cushing's disease? An analysis of possible influencing factors

S Siegel 1, D Starz 1, J Kohlmann 1, S Schlaffer 1, T Psaras 2, M Buchfelder 1, I Kreitschmann-Andermahr 1, 3
  • 1University Hospital Erlangen, Department of Neurosurgery, Erlangen, Germany
  • 2University Hospital Tuebingen, Department of Neurosurgery, Tuebingen, Germany
  • 3University Hospital Essen, Department of Neurosurgery, Essen, Germany

Introduction: Even years after successful treatment, psychosocial well-being and health-related quality of life (HRQoL) can be impaired in patients with Cushing's disease (CD). As the reasons for these long-term impairments are yet unclear, we conducted a postal survey to elucidate the role of possible influencing factors.

Methods: A set of self-assessment inventories including questionnaires on depression (Hospital Anxiety and Depression Scale, HADS), HRQoL (Short Form SF-36, Tuebingen Cushing's Disease CD-25), coping style (Freiburg Questionnaire on Coping with Illness, FKV-LIS) and disease history (self-developed) was sent to all patients with CD who had been operated upon ACTH-producing pituitary adenomas at the neurosurgical departments of Erlangen, Tuebingen and Essen during the last years. For the present analysis the Erlangen group of 101 patients (21 male, 80 female) has been regarded.

Results: At time of the survey (on average 6.2 y after diagnosis) 28.7% of the patients suffered from severely impaired psychological HRQol (SF-36 > 2 SD below mean), 11.9% from depression (HADS) and 22.8% from anxiety (HADS). Gender, age, rural vs. urban health care environment, length of the diagnostic process and number of doctors visited before diagnosis had no influence on psychosocial parameters. Patients with subnormal cortisol levels (20.8%) after treatment suffered more from impaired physical HRQol (p = 0.014) and depression (p = 0.17). Interestingly, maladaptive coping (FKV-LIS, „depressive coping“ and „minimizing importance“) correlated significantly with all scales measuring severity of depression, anxiety and impaired HRQoL (all p < 0.05).

Conclusion: While most of the investigated demographic and health care parameters seem to be unrelated to psychosocial well-being in CD, the latter is clearly influenced by the patient's way of dealing with the illness. Psychological trainings of positive coping styles could be a useful adjunct to the therapeutic regimen of CD.