Quality of Life in Patients with Cushing's Disease: A Modern Approach

Cushing’s disease (CD) is known to be associated with an increased mortality especially for cardiovascular diseases (1,2). Even years after cure, patients with a history of CD maintain an increased cardiovascular risk (3). The most important and frequent systemic complication in CD is represented by the metabolic syndrome, namely the combination of visceral obesity, systemic arterial hypertension, glucose intolerance and dyslipidemia, which together with thrombosis diathesis, is responsible for the increased cardiovascular risk (2,4). Glucocorticoids excess exerts important effects also on the skeletal system, determining osteoporosis, and on gonadal function, inducing polycystic ovary syndrome and menstrual disturbances in women or sexual dysfunction in men, with consequent damage of fertility. Overall, these complications induce significantly impaired health-related quality of life (HRQoL) which persists even after resolution of cortisol excess (2). Patients mainly complain of fatigue or weakness, changes in physical appearance, emotional instability, cognitive problems, depression and also sleeping difficulties; the majority of patients report interference with family life and relations with their partner and half of them with school or work performance (5). Despite successful treatment of CD, long-term residual effect on the HRQoL has been observed, which includes poorer physical and social functioning, role limitations due to physical and emotional problems, more pain, and less general wellbeing (5). The mechanisms through which CD determines HRQoL impairment are probably multifactorial involving physical and psychological features. Severe fatigability and changes in body composition and image, anxiety, irritability, mood swings, depression, decreased memory, less self-confidence, and difficulties in sleeping are common and the main concerns for these patients (5).