Mood and Quality of Life Improvements in Cushing Syndrome Post-Treatment
Overview
This prospective study of 67 patients with endogenous Cushing syndrome (CS) demonstrated significant improvements in quality of life (QoL), depression, and anxiety following biochemical control through surgery and/or medication. However, clinically meaningful recovery was variable, with approximately 53-68% of patients achieving minimal important differences in these domains.
Background
Cushing syndrome is a rare disorder characterized by chronic cortisol excess, leading to multiple comorbidities and neuropsychiatric disturbances such as depression and anxiety. These symptoms significantly impair patients' quality of life, which may persist even after treatment. Patient-reported outcomes (PROs) are valuable for assessing mood and QoL changes, but prior studies have been limited by small samples, short follow-up, and inconsistent findings regarding anxiety and depression recovery.
Data Highlights
Outcome Measure
Mean Change (±SD)
Minimal Important Difference (MID) Achieved (%)
CushingQoL (Quality of Life)
+18.2 ± 20.9
64.6%
Beck Depression Inventory-II (BDI-II)
−6.8 ± 8.6
67.9%
STAI-State Anxiety
−9.6 ± 12.5
53.2%
STAI-Trait Anxiety
−8.6 ± 12.6
52.8%
Key Findings
Significant improvements in QoL, depression, and anxiety scores were observed after biochemical control (all P < .001).
Clinically meaningful improvement (MID) was achieved in 64.6% for QoL, 67.9% for depression, and approximately 53% for anxiety subscales.
Predictors of QoL improvement included lower baseline BMI, symptom duration less than 3 years before treatment, postoperative hydrocortisone replacement longer than 6 months, and normal late-night salivary cortisol at follow-up.
Depression improvement was predicted by shorter symptom duration, normal follow-up cortisol levels, and surgical treatment.
Anxiety improvement was associated with younger age and extended postoperative hydrocortisone therapy.
Depression symptoms improved more gradually compared to QoL and anxiety.
Clinical Implications
Early diagnosis and treatment of Cushing syndrome are critical to optimize recovery of mood and quality of life. Posttreatment care should include monitoring and normalization of cortisol circadian rhythm and consideration of prolonged glucocorticoid replacement to support mood and anxiety improvements. Clinicians should be aware that some patients may experience incomplete or delayed recovery, necessitating comprehensive long-term support.
Conclusion
Effective biochemical control in Cushing syndrome leads to significant but variable improvements in quality of life, depression, and anxiety. These findings underscore the importance of timely diagnosis and tailored posttreatment management to enhance patient-centered outcomes.
References
Evaluation of Mood and Quality of Life Changes in Cushing Syndrome Patients Pre- and Post-Biochemical Management
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