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Lack of functional remission in Cushing’s syndrome

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Abstract

Introduction

Hypercortisolism leads to severe clinical consequences persisting after the onset of remission. These physical sequelae of cortisol exposure are known to profoundly impact the patient’s quality of life. As psychological factors may be correlated with this quality of life, our objective was to determine the specific weight of psychological determinants of quality of life in patients in remission from hypercortisolism.

Patients and methods

In an observational study, 63 patients with hypercortisolism in remission were asked to complete exhaustive self-administered questionnaires including quality of life (WHOQoL-BREF and Cushing QoL), depression, anxiety, self-esteem, body image, and coping scales. Multivariate analyses were performed. Psychological variables relevant to the model were: anxiety, depression, self-esteem, body image, and positive thinking dimension of the Brief-COPE. Cortisol deficiency was defined as a potential confounder.

Results

The median time since remission was 3 years. Patients had significantly lower quality of life and body satisfaction score than the French population and patients with chronic diseases. Depression significantly impaired all WHOQoL and Cushing QoL domains. A low body satisfaction score significantly impaired social relationships quality of life score. In total, 42.9% of patients still needed working arrangements, 19% had disability or cessation of work.

Conclusion

Patients in biological remission of hypercortisolism can rarely be considered as functionally cured: this is evidenced by altered quality of life, working arrangements, and chronic depression. A multidisciplinary management of these patients is thus mandatory on a long-term basis.

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Acknowledgements

We thank the patients and the members of the “Association Surrenales”, especially C. Colin and S. Templereau.

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Authors and Affiliations

  1. Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France

    M. Vermalle, T. Brue & F. Castinetti

  2. Department of Endocrinology, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005, Marseille, France

    M. Vermalle, T. Brue & F. Castinetti

  3. Aix Marseille University, Marseille, France

    M. Alessandrini & K. Baumstarck

  4. Department of endocrine surgery, La Conception Hospital, Marseille, France

    T. Graillon & H. Dufour

  5. Department of Neurosurgery, La Timone Hospital, Marseille, France

    N. C Paladino & F. Sebag

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  1. M. Vermalle
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  9. F. Castinetti
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Corresponding author

Correspondence to F. Castinetti.

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Conflict of interest

MV, MA, TG, CP, KB, FS, HD, TB, and FC declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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It was obtained from all individual participants included in the study.

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Vermalle, M., Alessandrini, M., Graillon, T. et al. Lack of functional remission in Cushing’s syndrome. Endocrine 61, 518–525 (2018). https://doi.org/10.1007/s12020-018-1664-7

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  • DOI: https://doi.org/10.1007/s12020-018-1664-7

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