BES2005 Poster Presentations Endocrine tumours and neoplasia (46 abstracts)
Comparison of long term psychological health in patients with treated Pituitary Cushing's and Nelson's syndrome vs. Adrenal Cushing's
S Ghosh 1 , AH Heald 1 , C Gibson 2 , S Bray 3 , SG Anderson 1 , K O'Driscoll 4 , JRE Davis 2 , H Buckler 1 & HL Fowler 3
1Department of Endocrinology, Salford Royal Hospitals NHS Trust, Salford, UK; 2Department of Endocrinology, Manchester Royal Infirmary, Manchester, UK; 3Department of Neuropsychology, Salford Royal Hospitals NHS Trust, Salford, UK; 4Department of Neuropsychiatry, Salford Royal Hospitals NHS Trust, Salford, UK.
Introduction
We have previously shown that patients with pituitary Cushing's have impaired quality of life vs. other pituitary tumour groups. Whether this is related to direct neural effects of excess ACTH or cortisol is uncertain. In order to address this, we compared patients who had undergone definitive treatment for pituitary vs adrenal Cushings.
Design
We assessed 14 patients with biochemically cured pituitary Cushing's (cure was defined by a normal 24 hour urine free cortisol excretion within the previous six months), 9 patients with Nelson's syndrome, 8 patients with cured adrenal Cushing's and 20 patients with non-functioning pituitary adenomas (controls). Psychological rating scales included General Health Questionnaire 28 (GHQ-28), Hospital Anxiety and Depression Scale (HADS-UK) and the World Health Organisation Quality of Life Scale (WHOQOL-BREF).
Results
Patients with treated pituitary Cushing's had higher GHQ total scores: 24 (95% CI 20-28) as did Nelson's syndrome patients: 24 (18-30) compared with non-functioning pituitary adenomas: 19 (16-22), F=3.2, p=0.02. Similar differences were seen with HADS-anxiety scores and WHOQOL psychological health. GHQ total scores were lower in treated adrenal Cushing's: 19 (17-21) than pituitary Cushing's or Nelson's (F=3.2, p=0.02). The highest levels of anxiety was found in patients with Nelson's syndrome (HADS: 10 (7-13), followed by pituitary Cushing's: 9 (6-12) and adrenal Cushing's, where scores were normal: 6 (4-8), F=3.8, p=0.01.
Discussion
Pituitary Cushing's disease (but not adrenal Cushing's), even when biochemically cured has long-term adverse effects on psychological well-being. Nelson's syndrome is associated with particularly high anxiety levels. These phenomena may be related to irreversible changes in neural pathways. However this is not to ignore the long term psychological impact of these chronic illnesses on the individual.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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