Cortisol diurnal rhythm and quality of life after successful medical treatment of Cushing’s disease

Cushing’s disease (CD) is associated with severely impaired quality of life (QoL). Moreover, the physiological cortisol diurnal rhythm (CDR) is disturbed in CD. QoL can improve after successful surgery, the primary treatment for CD. We evaluated the effects of medical treatment on QoL and CDR. In 17...

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Bibliographic Details
Published in:Pituitary 2013-12, Vol.16 (4), p.536-544
Main Authors: van der Pas, R., de Bruin, C., Pereira, A. M., Romijn, J. A., Netea-Maier, R. T., Hermus, A. R., Zelissen, P. M., de Jong, F. H., van der Lely, A. J., de Herder, W. W., Webb, S. M., Lamberts, S. W. J., Hofland, L. J., Feelders, R. A.
Format: Article
Language:English
Subjects:
Adult
Aged
Circadian Rhythm
Dopamine Agonists - therapeutic use
Endocrinology
Ergolines - therapeutic use
Female
Human Physiology
Humans
Hydrocortisone - blood
Hydrocortisone - metabolism
Ketoconazole - therapeutic use
Male
Medicine
Medicine & Public Health
Middle Aged
Pituitary ACTH Hypersecretion - blood
Pituitary ACTH Hypersecretion - drug therapy
Pituitary ACTH Hypersecretion - metabolism
Quality of Life
Somatostatin - analogs & derivatives
Somatostatin - therapeutic use
Surveys and Questionnaires
Young Adult
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Summary:Cushing’s disease (CD) is associated with severely impaired quality of life (QoL). Moreover, the physiological cortisol diurnal rhythm (CDR) is disturbed in CD. QoL can improve after successful surgery, the primary treatment for CD. We evaluated the effects of medical treatment on QoL and CDR. In 17 patients, stepwise medical treatment was applied with the somatostatin analog pasireotide, the dopamine agonist cabergoline and the adrenal-blocking agent ketoconazole. After 80 days, 15/17 (88 %) patients had reached normal urinary free cortisol excretion (UFC). Subsequently, patients continued medical therapy or underwent surgery. UFC, plasma and salivary CDR and QoL-related parameters (assessed using 5 questionnaires: Nottingham Health Profile, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Index-20, RAND-36, CushingQoL) were measured. At baseline, 5/17 patients had preserved CDR. In 6/12 patients with disturbed baseline CDR, recovery was observed, but without any correlation with QoL. QoL was significantly impaired according to 18/20 subscales in CD patients compared to literature-derived controls. According to the RAND-36 questionnaire, patients reported more pain at day 80 ( p  
ISSN:1386-341X
1573-7403
DOI:10.1007/s11102-012-0452-2