Cushing’s Syndrome Patients in Remission Rarely Recover Quality of Life, Study Suggests

Cushing’s syndrome patients deemed in biological remission are rarely functionally cured, continuing to report low quality of life scores, chronic depression, and the need for specific working arrangements in the long term, a study reports.

Researchers point to neurocognitive damage — mainly depression — as a major player in this impaired quality of life, and advise physicians to consider psychiatric consultations and antidepressants in this population.

The study, “Lack of functional remission in Cushing’s syndrome,” was published in the journal Endocrine.

Cushing’s syndrome can be debilitating physically, mentally, and often emotionally. Even with successful treatment, long-term residual effects have been observed in these patients, with studies reporting a persistence of obesity and a higher risk of cardiovascular issues.

Mental health is also affected in the long term, with some patients reporting anxiety and depression, along with suicidal thoughts up to five years after they reach clinical and biochemical remission.

Quality of life remains impaired for up to 15 years after a patient achieves normal cortisol levels, but studies on the impact of psychosocial factors — including anxiety, mood, self-esteem, and coping mechanisms — on the quality of life of Cushing’s patients are scarce.

Aiming to address this, researchers in France recruited 63 Cushing’s patients in remission and asked them to fill out several questionnaires assessing overall quality of life (WHOQoL-BREF and Cushing QoL), depression, anxiety, self-esteem, body image, and coping strategies. Patients, between the ages of 18 and 80, had been in remission for a median of three years.

Results showed that Cushing’s patients had a lower quality of life and body satisfaction scores than the overall French population and patients with chronic conditions. Impaired quality of life was mostly caused by physical factors, but psychological and social relationship domains were also affected.

Researchers found that most Cushing’s patients (61.9%) had low or very low self-esteem, and that 44.4% were likely to have depression. Anxiety was also seen in 57.1% of patients, but researchers believe these conditions were under-diagnosed, since only 27% of patients received psychiatric treatment.

“Of note, the length of remission did not significantly improve the anxiety and depression scores,” the researchers wrote.

Importantly, the study showed that 42.9% of patients required their workstation at their job to be adapted, and 19% had stopped working altogether.

“Despite clinical and biochemical remission, patients exposed to hypercortisolism do not show functional remission,” which is defined as recovery of social, professional, and personal levels of functioning, according to the researchers.

These patients mostly reported an impairment in their physical quality of life, and investigators propose that “patient care should be scaled up (with occupational and physical therapy) to improve physical consequences and body image.”

Researchers then examined how each of these factors influenced quality of life. Cortisol insufficiency — or the body’s inability to produce enough cortisol — influenced the physical aspects of quality of life, while low self-esteem had a significant impact on psychosocial aspects. Body satisfaction influenced a patient’s social relationships.

Depression, however, was the only factor significantly impacting all quality of life domains.

“This impaired quality of life is strongly correlated to neurocognitive damage, and especially depression,” the team concluded. “A psychiatric consultation should thus be systematically advised, and [anti-depressant] therapy should be discussed.”