Aix-Marseille Université, Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics (MMG), Marseille, France.
Department of Endocrinology, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille (AP-HM), Centre de Référence des Maladies Rares Hypophysaires HYPO 13005, Marseille, France.
Endocrine. 2018 Sep;61(3):518-525. doi: 10.1007/s12020-018-1664-7. Epub 2018 Jul 17.
Hypercortisolism leads to severe clinical consequences persisting after the onset of remission. These physical sequelae of cortisol exposure are known to profoundly impact the patient's quality of life. As psychological factors may be correlated with this quality of life, our objective was to determine the specific weight of psychological determinants of quality of life in patients in remission from hypercortisolism.
In an observational study, 63 patients with hypercortisolism in remission were asked to complete exhaustive self-administered questionnaires including quality of life (WHOQoL-BREF and Cushing QoL), depression, anxiety, self-esteem, body image, and coping scales. Multivariate analyses were performed. Psychological variables relevant to the model were: anxiety, depression, self-esteem, body image, and positive thinking dimension of the Brief-COPE. Cortisol deficiency was defined as a potential confounder.
The median time since remission was 3 years. Patients had significantly lower quality of life and body satisfaction score than the French population and patients with chronic diseases. Depression significantly impaired all WHOQoL and Cushing QoL domains. A low body satisfaction score significantly impaired social relationships quality of life score. In total, 42.9% of patients still needed working arrangements, 19% had disability or cessation of work.
Patients in biological remission of hypercortisolism can rarely be considered as functionally cured: this is evidenced by altered quality of life, working arrangements, and chronic depression. A multidisciplinary management of these patients is thus mandatory on a long-term basis.
皮质醇过多症导致缓解后仍持续存在严重的临床后果。皮质醇暴露的这些身体后遗症已知会严重影响患者的生活质量。由于心理因素可能与生活质量相关，我们的目标是确定皮质醇过多症缓解患者生活质量的心理决定因素的具体权重。
在一项观察性研究中，我们要求 63 名皮质醇过多症缓解患者完成详尽的自我管理问卷，包括生活质量（WHOQoL-BREF 和库欣生活质量）、抑郁、焦虑、自尊、身体形象和应对量表。进行了多变量分析。与模型相关的心理变量包括：焦虑、抑郁、自尊、身体形象和Brief-COPE 的积极思维维度。皮质醇缺乏被定义为潜在的混杂因素。
缓解后中位时间为 3 年。患者的生活质量和身体满意度评分明显低于法国人群和慢性病患者。抑郁显著损害了所有 WHOQoL 和库欣生活质量领域。低身体满意度评分显著损害了社会关系的生活质量评分。总的来说，42.9%的患者仍需要工作安排，19%的患者残疾或停止工作。
皮质醇过多症缓解后的患者几乎不能被认为是功能治愈的：这体现在生活质量、工作安排和慢性抑郁的改变上。因此，必须对这些患者进行长期的多学科管理。
