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Endocrine

, Volume 61, Issue 3, pp 518–525 | Cite as

Lack of functional remission in Cushing’s syndrome

  • M. Vermalle
  • M. Alessandrini
  • T. Graillon
  • N. C Paladino
  • K. Baumstarck
  • F. Sebag
  • H. Dufour
  • T. Brue
  • F. Castinetti
Original Article

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.

Notes

Acknowledgements

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

Compliance with ethical standards

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.

Informed consent

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

Supplementary material

12020_2018_1664_MOESM1_ESM.docx (51 kb)
Supplementary Information

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG)MarseilleFrance
  2. 2.Department of Endocrinology, Hôpital de la ConceptionAssistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005MarseilleFrance
  3. 3.Aix Marseille UniversityMarseilleFrance
  4. 4.Department of endocrine surgeryLa Conception HospitalMarseilleFrance
  5. 5.Department of NeurosurgeryLa Timone HospitalMarseilleFrance

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