Endocrine Abstracts

-Diana Borges Duarte and Francisca Puga are joint first authors and contributed equally

Background: As therapeutic options improve for Cushing’s disease (CD), most patients can now achieve control or cure of hypercortisolism. However, persistent complaints are often reported. Evaluation of health-related quality of life (HR-QoL) can highlight impairments beyond the stricter clinical aspects. Our aim was to evaluate HR-QoL with a specific focus on mental and emotional health subscales and to compare reported outcomes between patients with cure and persistent hypercortisolism under medical treatment.

Methods: Consecutive CD patients diagnosed between 2006 and 2020, with a minimum follow-up of 1 year, were invited, between June and August 2021, to complete a QoL evaluation. CushingQoL questionnaire was employed to assess disease-related quality of life. When analysing specific subscales on the questionnaire, the scores are based on Likert scales with five response categories (1-5 point-scale): the lower the score, the greater impact on HR-QoL. Clinical, anatomopathological and demographic data were retrieved from clinical records.

Results: Thirty-seven patients (86.5% females) agreed to complete the QoL assessment. Mean age at diagnosis was 42.2 ± 14.7 years and median time of onset of hypercortisolism symptoms was 2.0 (interquartile range 1.0-3.0) years. At the time of QoL evaluation, mean age was 48.0 ± 15.4 years and the median follow-up time was 4.1 (2.5-7.7) years. Concerning CD clinical status, 51.4% (n=19) were considered cured and 48.6% (n=18) had persistent CD (all patients were on medical therapy: n=6 on cabergoline monotherapy, n=4 on ketoconazole monotherapy, n= 3 on metyrapone monotherapy, the remainder in combination therapy). Median CushingQoL score was significantly higher in cured CD patients [68.8 (43.8-77.1) % in cured CD patients vs 35.4 (16.7-42.7) % in persistent CD patients, P=0.002]. Concerning the specific CushingQoL subscales, Mental Health [3.0 (2.0-3.0) points in cured CD patients vs 3.0 (2.0-3.0) points in persistent CD patients, P=0.73] and Emotional Health [3.0 (3.0-4.0) points in cured CD patients vs 3.0 (2.0-4.3) points in persistent CD patients, P=0.98] scores did not differ from the persistent hypercortisolism status.

Conclusion: In our cohort, clinical cure of CD was associated with higher health-related QoL score. However, equal scores on Mental and Emotional Health subscales were found. Either the impairment of these specific QoL domains persist beyond long-term control of hypercortisolism or medical treatment is associated with a surgical cure-comparable improvement of these domains while not achieving equal QoL scores on CushingQoL.