Approach to the Patient with Subclinical Cushing’s Syndrome

2020 ◽  
Vol 26 (43) ◽  
pp. 5584-5590
Author(s):  
Miomira Ivović ◽  
Ljiljana V. Marina ◽  
Antoan S. Šojat ◽  
Milina Tančić-Gajić ◽  
Zorana Arizanović ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Subclinical Cushing’S Syndrome ◽  
Number Of Patients ◽  
Health Quality ◽  
Health Quality Of Life

A growing number of patients with adrenal incidentalomas and subclinical Cushing’s syndrome (SCS) led to an increasing number of different guidelines, and diagnostic and treatment recommendations. Excess cortisol secretion in patients with SCS is associated with several comorbidities, such as hypertension, dyslipidemia, type 2 diabetes mellitus, and obesity, which in the long-term increase mortality of these patients. Subtle cortisol secretion affects bone health, quality of life and causes depression, but due to the unapparent clinical features, patients with SCS are often at risk between over and under treatment. This narrative review aimed to summarize the latest recommendations on the approach to the patient with subclinical Cushing’s syndrome.

scholarly journals Long-Term Impaired Quality of Life in Cushing’s Syndrome despite Initial Improvement after Surgical Remission

2006 ◽  
Vol 91 (2) ◽  
pp. 447-453 ◽  
Author(s):  
John R. Lindsay ◽  
Tonya Nansel ◽  
Smita Baid ◽  
Julie Gumowski ◽  
Lynnette K. Nieman
Keyword(s):  
Quality Of Life ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Initial Improvement ◽  
Impaired Quality

scholarly journals Characterization of PM10 Sampled on the Top of a Former Mining Tower by the High-Volume Wind Direction-Dependent Sampler Using INNA

Atmosphere ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 29
Author(s):  
Irena Pavlíková ◽  
Daniel Hladký ◽  
Oldřich Motyka ◽  
Konstantin N. Vergel ◽  
Ludmila P. Strelkova ◽  
...  
Keyword(s):  
Winter Season ◽  
Ground Level ◽  
High Volume ◽  
Limit Values ◽  
Health Quality ◽  
Health Quality Of Life

The PM10 concentrations in the studied region (Ostravsko-karvinská agglomeration, Czech Republic) exceed air pollution limit values in the long-term and pose a significant problem for human health, quality of life and the environment. In order to characterize the pollution in the region and identify the pollution origin, Instrumental Neutron Activation Analysis (INAA) was employed for determination of 34 elements in PM10 samples collected at a height of 90 m above ground level. From April 2018 to March 2019, 111 PM10 samples from eight basic wind directions and calm and two smog situations were sampled. The elemental composition significantly varied depending on season and sampling conditions. The contribution of three important industrial sources (iron and steelworks, cement works) was identified, and the long-range cross-border transport representing the pollution from the Polish domestic boilers confirmed the most important pollution inflow during the winter season.

scholarly journals Surviving ectopic Cushing’s syndrome: quality of life, cardiovascular and metabolic outcomes in comparison to Cushing’s disease during long-term follow-up

2018 ◽  
Vol 179 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Andrea Osswald ◽  
Timo Deutschbein ◽  
Christina M Berr ◽  
Eva Plomer ◽  
Anne Mickisch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cushing’S Syndrome ◽  
Psychiatric Morbidity ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Ectopic Cushing’S Syndrome ◽  
Cortisol Levels

Objective Aim of our study was to analyze long-term outcome of patients with the ectopic Cushing’s syndrome (ECS) compared to patients with Cushing’s disease (CD) regarding cardiovascular, metabolic, musculoskeletal and psychiatric comorbidities. Design Cross-sectional study in patients with ECS and CD in two German academic tertiary care centers. Methods Standardized clinical follow-up examination was performed including health-related quality of life (QoL) in 21 ECS patients in long-term remission (≥18 months since successful surgery). Fifty-nine patients with CD in remission served as controls. Results Time from first symptoms to diagnosis of Cushing’s syndrome (CS) was shorter in ECS than in CD (8.5 (IQR: 30.3) vs 25 (IQR: 39.0) months, P = 0.050). ECS patients had lower self-reported psychiatric morbidity compared to CD (19% vs 43%, P = 0.050) at follow-up. Moreover, female ECS patients reported favorable scores for QoL in the SF-36 questionnaire (mental health: 92 (IQR: 30) vs 64 (IQR: 32) in CD, P = 0.010) and a Cushing-specific QoL questionnaire (73 (IQR: 18) vs 59 (IQR: 36) in CD, P = 0.030). In a pooled analysis of ECS and CD patients, QoL correlated with time from first symptoms until diagnosis of CS, but not with urinary free cortisol levels or serum cortisol after dexamethasone at the time of diagnosis. Long-term outcomes regarding hypertension, metabolic parameters, bone mineral density and grip strength were comparable in ECS and CD. Conclusions Our data support the concept that time of exposure to glucocorticoid excess appears to be a better predictor than peak serum cortisol levels at the time of diagnosis regarding long-term psychiatric morbidity and QoL.

Factors Affecting Perceptions of Disability and Self-Rated Health Among Older Adult, Long-Term Cancer Survivors

2017 ◽  
Vol 31 (4) ◽  
pp. 667-684 ◽  
Author(s):  
Gary T. Deimling ◽  
Holly Pappada ◽  
Minzhi Ye ◽  
Elizabeth Nalepa ◽  
Spencier Ciaralli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Older Adult ◽  
Functional Difficulties ◽  
Self Rated Health ◽  
Perceptions Of Disability ◽  
Health Quality ◽  
Health Quality Of Life

Objective: This article examines the relative importance of cancer-related and noncancer illness factors as they predict the health quality of life among older adult, long-term cancer survivors. Specifically, it examines the effects that continuing cancer symptoms and comorbidities have on functional difficulties and how they in turn affect perceptions of disability and self-rated health. Method: Data from an National Cancer Institute (NCI)-funded, tumor registry–based 10-year study of 321 older adult (age 60+), long-term (5+years post diagnosis) survivors of breast colorectal and prostate cancer are examined using regression analyses. Results: The analyses documented the independent effects of both cancer-related and age-related health factors as they contribute to explaining functional difficulties, perceptions of disability and self-rated health. Gender and racial differences in health quality of life were also identified. Discussion: The findings suggest that geriatricians, geriatric nurses, and clinical gerontologists who work with cancer survivorsneed to be aware of the ways in which both cancer and noncancer illness factors work together in producing threats to health quality of life through the extent and nature of functional impairments.

scholarly journals Negative illness perceptions are associated with impaired quality of life in patients after long-term remission of Cushing's syndrome

2011 ◽  
Vol 165 (4) ◽  
pp. 527-535 ◽  
Author(s):  
Jitske Tiemensma ◽  
Adrian A Kaptein ◽  
Alberto M Pereira ◽  
Johannes W A Smit ◽  
Johannes A Romijn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vestibular Schwannoma ◽  
Cushing’S Syndrome ◽  
Intervention Program ◽  
Illness Perceptions ◽  
Illness Perception ◽  
Cushing's Syndrome ◽  
Chronic Obstructive

ObjectiveIllness perceptions pertain to the pattern of beliefs patients develop about their illness. Illness perceptions are determinants of quality of life (QoL). Factors contributing to persisting impaired QoL after Cushing's syndrome (CS) remain largely unknown. Therefore, the objective of this study was to explore illness perceptions, as potentially modifiable psychological factors, in relation to QoL in patients with long-term remission of CS.DesignCross-sectional study.MethodsWe included patients with long-term remission of CS (n=52). Illness perceptions were evaluated using the Illness Perception Questionnaire (IPQ)-Revised, and QoL was measured using the physical symptom checklist, EuroQoL-5D (EQ-5D), and the CushingQoL. Reference data were derived from recent studies and included patients with vestibular schwannoma (n=80), acute (n=35) or chronic (n=63) pain, and chronic obstructive pulmonary disease (COPD; n=171).ResultsIllness perceptions showed a strong correlation with QoL. Patients with CS scored distinctively more negative on the IPQ compared with patients with vestibular schwannoma and patients with acute pain, and also reported more illness-related complaints (all P<0.01). There were also some differences in illness perceptions between patients with CS and patients with chronic pain and patients with COPD, but there was no distinct pattern.ConclusionsPatients after long-term remission of CS report more negative illness perceptions compared with patients with other acute or chronic conditions. Further research is needed to assess whether QoL in CS can be improved by addressing these illness perceptions, for example, by a self-management intervention program.

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