Predictors of quality of life in 102 patients with treated Cushing's disease.

OBJECTIVE: To identify predictors for quality of life (QoL) in treated Cushing's disease (CD) and quantify patients' assessment of their disease status. CONTEXT: Significant reductions in QoL exist in CD patients despite treatment. Identifying predictors of QoL is paramount to the long-term management of these patents. DESIGN: A cross-sectional study was conducted of patients with treated CD. Patients completed a medical history questionnaire and three validated quality of life assessments: Cushing's QoL Questionnaire (CushingQoL), Hospital Anxiety and Depression Scale (HADS) and Nottingham Health Profile (NHP). PATIENTS: 102 patients (75·7% female, mean time since surgery 7·4 years) with treated CD were included. MEASUREMENTS: Patients were categorized by biochemical and self-identified disease status. Mean CushingQoL, anxiety and depression scores were compared by unpaired t-tests. Multiple linear regressions were performed on the whole cohort to assess for predictors of impaired QoL. RESULTS: Ninety-two per cent of the cohort met criteria for biochemical remission, but only 80·4% felt they had achieved remission. Among those with biochemical remission, those who also self-identified as being in remission had higher CushingQoL scores than those who self-identified as having persistent disease (P = 0·042). Anxiety (P = 0·032) and depression (P = 0·018) scores were lower, and CushingQoL scores were higher (P = 0·05) in patients who self-identified as being in remission compared to persistence. Recovery time, BMI, gender and age were also predictors for QoL. CONCLUSION: Our study identifies the discordance that can exist between biochemical and self-assessed disease status and demonstrates its impact on QoL in patients with CD. These findings highlight the importance of incorporating patients' disease perceptions in their management.

Predictors of mortality and long-term outcomes in treated Cushing's disease: a study of 346 patients.

CONTEXT: Active Cushing's disease (CD) confers a 4-fold increase in mortality and is associated with significant morbidities. Although excess mortality risk may persist even after CD treatment, predictors of risk in treated CD are not well understood. OBJECTIVE: To identify predictors of mortality, cardiovascular (CV) disease, and recurrence after long-term follow-up among patients with treated CD. DESIGN, SETTING, AND PATIENTS: A retrospective chart review was conducted to evaluate patients with CD who underwent transsphenoidal adenectomy with a single surgeon. OUTCOME MEASURES: Patients were categorized based on disease response after initial treatment. Cox proportional hazard models identified predictors of mortality, recurrence, and CV outcomes in the overall cohort and each subgroup. RESULTS: Three hundred forty-six subjects were included. Mean age was 39.9 years, and mean duration of follow-up was 6.3 years (range, 1 mo to 30 y). Duration of exposure to excess glucocorticoids, estimated by duration of symptoms before diagnosis until remission was achieved by any means, was 40.0 months. Multivariate analyses demonstrated that duration of glucocorticoid exposure elevated the risk of death (P = .038), as did older age at diagnosis (P = 0.0001) and preoperative ACTH concentration (P = .007). Among patients who achieved remission, depression increased the hazard of death (P < .01). Male sex, age at diagnosis, diabetes, and depression elevated the risk of CV disease (P < .05). CONCLUSION: Long-term follow-up of a large cohort of treated patients with CD identified several novel predictors of mortality. These data illustrate the importance of early recognition and treatment of CD. Long-term follow-up, with management of persistent comorbidities, is needed even after successful treatment of CD.

Male osteoporosis: epidemiology and the pathogenesis of aging bones.

Osteoporosis in men is an overlooked yet increasingly important clinical problem that, historically, has not received the same degree of awareness as with women. Epidemiologic studies demonstrate that male osteoporosis contributes significantly to the burden of osteoporotic fractures, especially among the aging population. In particular, men have increased morbidity and mortality associated with osteoporotic fractures compared with women. Diagnostic challenges of male osteoporosis include lack of consensus about appropriate reference ranges for identifying osteoporosis in men, and the lack of a fracture assessment tool in men necessary to identify those individuals at risk. Compared with women, changes that occur in the aging male skeleton include trabecular thinning, greater endocortical expansion, ongoing periosteal apposition with greater bending strength, and preserved minimum moment of inertia. Overall, men have less microstructural damage with aging and beneficial geometric adaptations that lead to stronger bones, compared with women, and thus their overall lower risk of fractures.