Pain characteristics in patients with Cushing's disease compared to patients with non-functioning pituitary adenomas
Christina Dimopoulou1, Franziska Oehrlein1, Hildegard Pfister1, Jochen Schopohl2, Guenter Karl Stalla1 & Caroline Sievers1
Objectives: It is known that patients with pituitary adenomas, especially acromegaly, frequently suffer from pain syndromes such as headache and arthralgia. Whether pain exists and to what extent in Cushings disease (CD), reflecting chronic cortisol excess, is not clear. We hypothesized that pain patterns should be also altered and investigated pain laterisation, clinical characteristics, phenotypes as well as underlying predictors.
Methods: In a cross-sectional study, we assessed 50 patients with CD and compared them to 60 patients with non-functioning pituitary adenomas (NFPA). Specific pain patterns were measured using three standardized pain questionnaires, MIDAS (Migraine Disability Assessment), the painDETECT and the DGSS (German Society for the Study of Pain) questionnaire.
Results: According to the DGSS questionnaire, patients with CD complained significantly more often of any sort of pain (76.0 versus 51.7%; P=0.010) compared to patients with NFPA. In the MIDAS headache questionnaire, CD patients presented with significantly reduced productivity at work or school because of headache in the last 3 months (9.78±3.15 versus 2.25±1.12 days; P=0.028) as well as elevated headache intensity (pain intensity scale: 0=no pain, 10=highest intensity) (4.11±0.5 versus 1.54±0.38; P=0.000) compared to controls. The screening for neuropathic vs. nociceptive pain via painDETECT showed significant differences between CD and NFPA patients as far as the highest (6.05±0.46 versus 3.98±0.44; P=0.002) and average pain intensity during the past 4 weeks (3.73±0.34 versus 2.63±0.33; P=0.022) were concerned.
Conclusions: All three questionnaires revealed a high burden of diverse pain syndromes in patients with pituitary adenomas. Moreover, patients with CD demonstrated a distinct pattern regarding frequency, duration and intensity of pain, possibly linked to cortisol excess. Specific treatment should be offered for those patients with CD associated pain syndromes.