Persistent hypocortisolism in Cushing's disease and persistent comorbidities in acromegaly determine neurocognitive function and quality of life after surgical treatment
Tsambika Psaras, Juergen Honegger & Monika Milian
Objective: Cushings disease (CD) and acromegaly (AC) are associated with psychological and psychiatric problems. Both pathologies cause a severe impairment in quality of life (QoL) that can persist even if biochemical remission and cure are achieved. The aim of the study was to investigate the influence of the current disease status (remission vs. no remission) on neurocognitive function and QoL in treated CD and AC patients. The second objective was to determine predictive factors that determine postoperative neuropsychological function and QoL.
Methods: CD and 37 AC patients underwent neuropsychological testing. The SF-36, SCL-90-R and AcroQoL questionnaires were applied to assess QoL. CD patients underwent a dexamethasone-suppression-test, IGF-1 levels were assessed in AC patients to determine the current disease status. The results were compared with 28 sex-, education- and age-matched healthy controls (HC).
Results: Limitations in QoL evaluated for both pathologies compared to the HC were more pronounced than neurocognitive decrease. This finding was independent of the current status of disease (remission vs. no remission). Regression analyses revealed young age at operation and comorbidities to predict adverse postoperative outcome in AC. Persistent hypocortisolism was best associated with impaired neurocognition and QoL in CD.
Conclusions: In both pathologies, the current status of disease does not play the major role in postoperative outcome. A possible explanation might be the considerably improved endocrinopathy after treatment, even if no actual cure is achieved.