Treatment of Cushing syndrome improves but does not normalize QoL, cognitive functioning

Quality of life (QoL) and cognitive functioning improve but do not normalize with treatment of Cushing syndrome, reports a recent study.

“Because normalization was not achieved in QoL and in some aspects of cognitive functioning, special and continuous attention should be given to these aspects for patients after treatment,” the authors said. “Effective interventions for further improvement and possibly normalization are urgently needed.”

In this systematic review and meta-analysis, potentially relevant articles were identified in eight electronic databases in March 2017, and PubMed again in May 2018. Randomized controlled trials, cohort studies and cross-sectional studies that evaluated quality of life or cognitive functioning in patients treated for Cushing syndrome were included in the analysis.

Differences were conveyed as standardized mean difference and reported with 95 percent confidence intervals. The authors compared patients before and after treatment (improvement) and patients after treatment and health controls (normalization).

Forty-seven articles including a total of 2,643 patients met the inclusion criteria. Majority of the patients had Cushing disease and were in remission following treatment. In all studied domains, improvements in QoL and cognitive functioning were observed after treatment.

However, QoL did not normalize when compared with a healthy control population. Normalization occurred in cognitive functioning in part—but not all—of the studied domains.

“Cushing syndrome is characterized by glucocorticoid excess, which induces physical and mental symptoms, impairments in functional status and perceived health, resulting in impaired QoL,” the authors said. “Biochemical remission is urgently required; however, QoL and cognitive function may remain impaired.”