The burden of Cushing's disease: clinical and health-related quality of life aspects.
OBJECTIVE
Cushing's disease (CD) is a rare endocrine disorder characterized by excess secretion of ACTH due to a pituitary adenoma. Current treatment options are limited and may pose additional risks. A literature review was conducted to assess the holistic burden of CD.


METHODS
Studies published in English were evaluated to address questions regarding the epidemiology of CD, time to diagnosis, health-related quality of life (HRQoL), treatment outcomes, mortality, prevalence of comorbidities at diagnosis, and reversibility of comorbidities following the treatment.


METHODS
a two-stage literature search was performed in Medline, EMBASE, and Science Citation Index, using keywords related to the epidemiology, treatment, and outcomes of CD: i) articles published from 2000 to 2012 were identified and ii) an additional hand search (all years) was conducted on the basis of bibliography of identified articles.


RESULTS
At the time of diagnosis, 58-85% of patients have hypertension, 32-41% are obese, 20-47% have diabetes mellitus, 50-81% have major depression, 31-50% have osteoporosis, and 38-71% have dyslipidemia. Remission rates following transsphenoidal surgery (TSS) are high when performed by expert pituitary surgeons (rates of 65-90%), but the potential for relapse remains (rates of 5-36%). Although some complications can be partially reversed, time to reversal can take years. The HRQoL of patients with CD also remains severely compromised after remission.


CONCLUSIONS
These findings highlight the significant burden associated with CD. As current treatment options may not fully reverse the burden of chronic hypercortisolism, there is a need for both improved diagnostic tools to reduce the time to diagnosis and effective therapy, particularly a targeted medical therapy.
Endocrine Section, Department of Internal Medicine, Erasmus Medical Center Rotterdam, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. r.feelders@erasmusmc.nl
R A
RA
Feelders
S J
SJ
Pulgar
A
A
Kempel
A M
AM
Pereira
D017281:Cost of Illness; D006801:Humans; D047748:Pituitary ACTH Hypersecretion / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology