scholarly journals Patient and provider perspectives on post-surgical recovery of Cushing’s syndrome

2021 ◽  
Author(s):  
Rachel Acree ◽  
Caitlin M Miller ◽  
Brent S Abel ◽  
Nicola M Neary ◽  
Karen Campbell ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Complete Recovery ◽  
Coping Mechanisms ◽  
Cushing's Syndrome ◽  
Sufficient Information ◽  
Surgical Experience ◽  
Cross Sectional ◽  
Provider Perspectives ◽  
Related Quality ◽  
Patient And Provider Perspectives

Abstract Context Cushing’s syndrome (CS) is associated with impaired health-related quality of life (HRQOL) even after surgical cure. Objective To characterize patient and provider perspectives on recovery from CS, drivers of decreased HRQOL during recovery, and ways to improve HRQOL. Design Cross-sectional observational survey Participants Patients (n=341) had undergone surgery for CS and were members of the Cushing’s Support and Research Foundation. Physicians (n=54) were Pituitary Society physician members and academicians who treated patients with CS. Results Compared to patients, physicians underestimated the time to complete recovery after surgery (12 months vs 18 months, p=0.0104). Time to recovery did not differ by CS etiology, but patients with adrenal etiologies of CS reported a longer duration of cortisol replacement medication (CRM) compared to patients with Cushing’s disease (12 months vs 6 months, p=0.0025). Physicians overestimated the benefits of work (26.9% vs 65.3%, p <0.0001), exercise (40.9% vs 77.6%, p=0.0001), and activities (44.8% vs 75.5%, p=0.0016) as useful coping mechanisms in the post-surgical period. Most patients considered family/friends (83.4%) and rest (74.7%) to be helpful. All physicians endorsed educating patients on recovery, but 32.4% (95% CI 27.3%-38.0%) of patients denied receiving sufficient information. Some patients did not feel prepared for the post-surgical experience (32.9%, 95% CI 27.6%-38.6%) and considered physicians not familiar enough with CS (16.1%, 95% CI 12.2%-20.8%). Conclusion Poor communication between physicians and CS patients may contribute to dissatisfaction with the post-surgical experience. Increased information on recovery, including helpful coping mechanisms, and improved provider-physician communication may improve HRQOL during recovery.

scholarly journals A direct comparison of quality of life in obese and Cushing's syndrome patients

2013 ◽  
Vol 168 (5) ◽  
pp. 787-793 ◽  
Author(s):  
Smita Baid Abraham ◽  
Brent S Abel ◽  
Domenica Rubino ◽  
Tonja Nansel ◽  
Sheila Ramsey ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cushing’S Syndrome ◽  
Cross Sectional Study ◽  
Cushing's Syndrome ◽  
Cross Sectional ◽  
Clinical Center ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

ObjectiveObese (OB) individuals and patients with Cushing's syndrome (CS) often have similar clinical presentations. While each group has reduced health-related quality of life (HRQL), it is not known whether the degree of impairment is different and might distinguish between them. The objective of this study was to compare HRQL in these two populations.DesignCross-sectional study.MethodsThree hundred and twenty-seven OB patients (48.1±11.7 years; 72.5% women) with weight gain and at least two features of CS were recruited from an outpatient weight management clinic. Sixty-six untreated patients with CS (41.6±13.2 years; 78.8% women) presented to the NIH Clinical Center for evaluation. Subjects completed the SF-36 survey and a locally created symptom questionnaire.ResultsAfter adjusting for symptom count, OB patients had a significantly higher (better HRQL) mean physical component summary (PCS) score than CS patients (44.9±0.6 vs 35.4±1.5, P<0.0001). However, the mean mental component summary (MCS) score was lower (worse HRQL) in the OB group (41.6±0.6 vs 50.7±1.6, P<0.0001). Symptom count showed significant correlations with PCS and MCS scores. BMI correlated with PCS (r=−0.29) in OB but not in CS patients. BMI was not associated with MCS in either group.ConclusionHRQL is significantly different between OB and CS patients. Surprisingly, after adjusting for symptom count, OB patients showed worse mental health scores than the CS population. Significant differences in HRQL and symptom count may suggest which OB patients should be screened for CS.

scholarly journals Frequency of Osteoporosis in Iatrogenic Cushing’s syndrome: Scenario of outpatient department in urban hospitals

2020 ◽  
Vol 31 (1) ◽  
pp. 18-21
Author(s):  
Tamanna Bahar ◽  
Shaila Rahman ◽  
Lilian Catherene Gomes ◽  
Mohammad Murad Hossain ◽  
Zulfia Zinat Chowdhury ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing Syndrome ◽  
Reference Population ◽  
Final Diagnosis ◽  
Cushing's Syndrome ◽  
Outpatient Department ◽  
Clinical Feature ◽  
Cross Sectional ◽  
Prevalence Of Osteoporosis ◽  
Iatrogenic Cushing’S Syndrome

Background: Cushing’s syndrome is caused by excessive activation of glucocorticoid receptor. Iatrogenic Cushing syndrome is the prevalent one world -wide .Patients with Cushing’s syndrome has a high prevalence of osteoporosis. Objective: To see the prevalence of osteoporosis in Iatrogenic Cushing’s syndrome patient. Method: This descriptive cross-sectional study included 211 diagnosed case of Cushing’s syndrome during the time period of December 2013 to December 2018 in outpatient department of Dhaka Medical College and Health and Hope Hospital. Final diagnosis was done on the basis of clinical feature, serum basal cortical level and BMD. We found male were prevalent one (56%).80.56% showed biochemical evidence of Cushing’s syndrome. BMD was done in 113 patients compared with a reference population by means of T score, 17.69% patient in osteoporotic range. Conclusion: The prevalence of osteoporosis and osteopenia is age and sex independent. Judicial use of steroid and co administration with calcium, bisphosphonate can prevent osteoporosis. Treatment with bisphosphonates should be considered in all patients (irrespective of age) with Cushing’s syndrome with a low BMD to reduce fracture. Bangladesh J Medicine Jan 2020; 31(1) : 18-21

scholarly journals Improvement but no normalization of quality of life and cognitive functioning after treatment for Cushing’s syndrome

2019 ◽  
Author(s):  
Leonie H A Broersen ◽  
Cornelie D Andela ◽  
Olaf M Dekkers ◽  
Alberto M Pereira ◽  
Nienke R Biermasz
Keyword(s):  
Quality Of Life ◽  
Cognitive Functioning ◽  
Cushing’S Syndrome ◽  
Meta Analysis ◽  
Cushing's Syndrome ◽  
Treatment Quality ◽  
Cross Sectional ◽  
Effective Interventions ◽  
Before And After

Abstract Background Cushing’s syndrome is characterized by glucocorticoid excess, which induces physical and mental symptoms, impairments in functional status and perceived health, resulting in impaired quality of life. Biochemical remission is urgently required; however, quality of life and cognitive function may remain impaired. Objective To perform a systematic review and meta-analysis evaluating changes in health-related quality of life and cognitive functioning in patients with Cushing’s syndrome after treatment. Methods Eight electronic databases were searched in March 2017, and PubMed again in May 2018, to identify potentially relevant articles. Eligible studies were (randomized controlled) trials, cohort studies, and cross-sectional studies assessing quality of life or cognitive functioning in patients treated for Cushing’s syndrome. Differences were expressed as standardized mean difference, and reported with 95% confidence intervals. We compared patients before and after treatment (improvement), and patients after treatment and healthy controls (normalization). Results We included 47 articles with 2,643 patients. Most patients had Cushing’s disease and were in remission after treatment. Quality of life and cognitive functioning improved after treatment in all studied domains. Compared to a healthy control population, quality of life did not normalize. Cognitive functioning normalized in part, but not all, of the studied domains. Conclusions Treatment of Cushing’s syndrome improves quality of life and cognitive functioning. As normalization was not achieved in quality of life and in some aspects of cognitive functioning, special and continuous attention should be given to these aspects for patients after treatment. Effective interventions for further improvement and possibly normalization are urgently needed.

scholarly journals Development and evaluation of a health‐related quality‐of‐life tool for dogs with Cushing's syndrome

2019 ◽  
Vol 33 (6) ◽  
pp. 2595-2604 ◽  
Author(s):  
Imogen Schofield ◽  
Dan G. O'Neill ◽  
Dave C. Brodbelt ◽  
David B. Church ◽  
Rebecca F. Geddes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Health Related Quality ◽  
Life Tool ◽  
Related Quality ◽  
Health Related

scholarly journals Cortisol-related metabolic alterations assessed by mass spectrometry assay in patients with Cushing's syndrome

2017 ◽  
Vol 177 (2) ◽  
pp. 227-237 ◽  
Author(s):  
Guido Di Dalmazi ◽  
Marcus Quinkler ◽  
Timo Deutschbein ◽  
Cornelia Prehn ◽  
Nada Rayes ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Diabetic Patients ◽  
Contributing Factors ◽  
Metabolic Disturbances ◽  
Cross Sectional ◽  
Metabolic Alterations ◽  
Metabolomic Profiling ◽  
Metabolic Inflexibility

Objective Endogenous hypercortisolism is a chronic condition associated with severe metabolic disturbances and cardiovascular sequela. The aim of this study was to characterize metabolic alterations in patients with different degrees of hypercortisolism by mass-spectrometry-based targeted plasma metabolomic profiling and correlate the metabolomic profile with clinical and hormonal data. Design Cross-sectional study. Methods Subjects (n = 149) were classified according to clinical and hormonal characteristics: Cushing’s syndrome (n = 46), adrenocortical adenomas with autonomous cortisol secretion (n = 31) or without hypercortisolism (n = 27). Subjects with suspicion of hypercortisolism, but normal hormonal/imaging testing, served as controls (n = 42). Clinical and hormonal data were retrieved for all patients and targeted metabolomic profiling was performed. Results Patients with hypercortisolism showed lower levels of short-/medium-chain acylcarnitines and branched-chain and aromatic amino acids, but higher polyamines levels, in comparison to controls. These alterations were confirmed after excluding diabetic patients. Regression models showed significant correlation between cortisol after dexamethasone suppression test (DST) and 31 metabolites, independently of confounding/contributing factors. Among those, histidine and spermidine were also significantly associated with catabolic signs and symptoms of hypercortisolism. According to an discriminant analysis, the panel of metabolites was able to correctly classify subjects into the main diagnostic categories and to distinguish between subjects with/without altered post-DST cortisol and with/without diabetes in >80% of the cases. Conclusions Metabolomic profiling revealed alterations of intermediate metabolism independently associated with the severity of hypercortisolism, consistent with disturbed protein synthesis/catabolism and incomplete β-oxidation, providing evidence for the occurrence of metabolic inflexibility in hypercortisolism.

scholarly journals Support Needs of Patients with Cushing’s Disease and Cushing’s Syndrome: Results of a Survey Conducted in Germany and the USA

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ilonka Kreitschmann-Andermahr ◽  
Sonja Siegel ◽  
Christa Gammel ◽  
Karen Campbell ◽  
Leslie Edwin ◽  
...  
Keyword(s):  
Medical Care ◽  
Cushing’S Syndrome ◽  
Cushing’S Disease ◽  
Disease Burden ◽  
Cushing's Syndrome ◽  
Cushing's Disease ◽  
Support Needs ◽  
Cross Sectional ◽  
Patient Support Group

Background. Cushing’s disease (CD) and Cushing’s syndrome (CS) are chronic illnesses, characterized by symptoms of prolonged hypercortisolism, which often changes to hypocortisolism after successful treatment. In view of the high disease burden of CD/CS patients and long-term impaired quality of life, the present survey was conducted to gain information about subjective illness distress and patients’ specific needs in terms of supportive measures beyond medical interventions. Patients and Methods. Cross-sectional questionnaire study including patients with CD treated in 2 German neurosurgical tertiary referral centers and CD/CS patient members of a US-based patient support group completed a survey inquiring about disease burden, coping strategies, and support needs. Additionally, the degree of interest in different offers, e.g., internet-based programs and seminars, was assessed. Results. 84 US and 71 German patients answered the questionnaire. Patients in both countries indicated to suffer from Cushing-related symptoms, reduced performance, and psychological problems. 48.8% US patients and 44.4% German patients stated that good medical care and competent doctors helped them the most in coping with the illness. US patients were more interested in support groups (p=0.035) and in courses on illness coping (p=0.008) than the German patients, who stated to prefer brochures (p=0.001). 89.3% of US patients would attend internet-based programs compared to 75.4% of German patients (p=0.040). There were no differences between groups for the preferred duration of and the willingness to pay for such a program, but US patients would travel longer distances to attend a support meeting (p=0.027). Conclusion. Patients in both countries need skilled physicians and long-term medical care in dealing with the effects of CD/CS, whereas other support needs differ between patients of both countries. The latter implies that not only disease-specific but also culture-specific training programs would need to be considered to satisfy the needs of patients in different countries.

Muscle strength in Cushing's syndrome: cross-sectional evaluation of the German Cushing's registry

2016 ◽  
Author(s):  
Christina M Berr ◽  
Marcus Quinkler ◽  
Mareike Stieg ◽  
Timo Deutschbein ◽  
Andrea Osswald ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Cross Sectional

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Cushing's syndrome: a structured short- and long-term management plan for patients in remission

2013 ◽  
Vol 169 (5) ◽  
pp. R139-R152 ◽  
Author(s):  
Oskar Ragnarsson ◽  
Gudmundur Johannsson
Keyword(s):  
Cushing’S Syndrome ◽  
Management Plan ◽  
Postoperative Management ◽  
Cushing's Syndrome ◽  
Postoperative Phase ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related ◽  
Term Management

One hundred years have passed since Harvey Williams Cushing presented the first patient with the syndrome that bears his name. In patients with Cushing's syndrome (CS), body composition and lipid, carbohydrate and protein metabolism are dramatically affected and psychopathology and cognitive dysfunction are frequently observed. Untreated patients with CS have a grave prognosis with an estimated 5-year survival of only 50%. Remission can be achieved by surgery, radiotherapy and sometimes with medical therapy. Recent data indicate that the adverse metabolic consequences of CS are present for years after successful treatment. In addition, recent studies have demonstrated that health-related quality of life and cognitive function are impaired in patients with CS in long-term remission. The focus of specialised care should therefore be not only on the diagnostic work-up and the early postoperative management but also on the long-term follow-up. In this paper, we review the long-term consequences in patients with CS in remission with focus on the neuropsychological effects and discuss the importance of these findings for long-term management. We also discuss three different phases in the postoperative management of surgically-treated patients with CS, each phase distinguished by specific challenges: the immediate postoperative phase, the glucocorticoid dose tapering phase and the long-term management. The focus of the long-term specialised care should be to identify cognitive impairments and psychiatric disorders, evaluate cardiovascular risk, follow pituitary function and detect possible recurrence of CS.

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