Bilateral adrenalectomy in Cushing's disease: Altered long-term quality of life compared to other treatment options

Bilateral adrenalectomy (BADX) has become an important treatment of Cushing's disease (CD), especially when other treatment options have failed. The aim of this study was to evaluate the long-term quality of life (QoL) of patients having undergone BADX for CD, in comparison to other therapeutic options.

Thirty-four patients with CD were identified in two French centers: 17 underwent BADX and the remaining 17 one or more of the following treatments: surgery, medical therapy or radiotherapy. Three questionnaires were filled in by each patient in order to evaluate their QoL: Short Form-36 Health Survey (SF-36), Cushing QoL questionnaire and Beck depression inventory (BDI).

The mean age of patients was 49.3±15.2 years. Average time lapse between diagnosis and BADX was 6.1 years. Results from each questionnaire adjusted to age showed a lower QoL among patients who underwent BADX. These were significant in most aspects of the SF-36 questionnaire (bodily pain P<0.01, general health P<0.01, vitality P≤0.05, social functioning P≤0.05), as well as in the Cushing QoL questionnaire (P<0.05) and BDI (P≤0.05). Adrenal insufficiency appeared to be the major predictor of poor QoL whatever their initial treatment.

Despite their clinical remission, patients who undergo BADX appear to be at a greater risk of suffering an impaired QoL due to more prolonged period of time with imperfectly controlled hypercortisolism combined with definitive adrenal insufficiency.

Annales d'endocrinologie. 2018 Sep 19 [Epub ahead of print]

Pauline Sarkis, Muriel Rabilloud, Jean-Christophe Lifante, Anna Siamand, Emmanuel Jouanneau, Emmanuel Gay, Philippe Chaffanjon, Olivier Chabre, Gérald Raverot

Fédération d'endocrinologie, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France. Electronic address: ., Service de biostatistique et bioinformatique, hospices civils de Lyon, 69003 Lyon, France; Université de Lyon, 69000 Lyon, France; Université Lyon 1, 69100 Villeurbanne, France; CNRS, UMR 5558, laboratoire de biométrie et biologie évolutive, équipe biostatistique-santé, 69100 Villeurbanne, France., Service de chirurgie générale digestive et endocrinienne, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69495, Pierre-Bénite, France., Endocrinologie, pavillon des Écrins, centre hospitalier universitaire de Grenoble, CS 10217, 38043 Grenoble cedex 9, France., Service de neurochirurgie, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France., Service de neurochirugie, centre de recherche Inserm U836 UJF-CEA-CHU, Grenoble institut des neurosciences, centre hospitalier universitaire, équipe 7, bâtiment Edmond-J.-Safra, chemin Fortuné-Ferrini, 38700 La Tronche, France., Département de chirurgie thoracique, vasculaire et endocrinienne, LADAF-laboratoire d'anatomie des Alpes françaises, université Grenoble Alpes, UFR de médecine, CHU Grenoble-Alpes, 38700 La Tronche, France., Fédération d'endocrinologie, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Lyon, France; Inserm U1052, CNRS UMR5286, Lyon I university, signaling, metabolism and tumor progression, cancer center of Lyon, centre Léon-Bérard, bâtiment Cheney D-5th Floor, 28, rue Laennec, 69008 Lyon, France.