title: Psychological morbidity and impaired quality of life in patients with stable treatment for primary adrenal insufficiency: cross-sectional study and review of the literature.
abstract: BACKGROUND
  A high prevalence of psychological morbidity and maladaptive personality as well as impaired quality of life (QoL) is observed in patients with and without hydrocortisone dependency following (cured) Cushing's syndrome. However, it is currently unclear whether a similar pattern is present in patients with chronic glucocorticoid replacement for primary adrenal insufficiency (PAI).
  
  
  OBJECTIVE
  To evaluate psychological functioning, personality traits, and QoL in patients with PAI.
  
  
  METHODS
  A cross-sectional study including 54 patients with stable treatment for PAI and 54 healthy matched controls. Both patients and controls completed questionnaires on psychological functioning (Apathy Scale, Irritability Scale, Mood and Anxiety Symptoms Questionnaire short form, and Hospital Anxiety and Depression Scale), personality traits (Dimensional Assessment of Personality Pathology short form), and QoL (Multidimensional Fatigue Inventory, Short Form 36, EuroQoL-5D, Nottingham Health Profile, and Physical Symptom Checklist).
  
  
  RESULTS
  Patients with PAI suffered from more psychological morbidity (i.e. irritability and somatic arousal) and QoL impairments compared with controls (all P<0.01). There were no differences regarding maladaptive personality traits between patients and controls. However, there was a strong and consistent positive association between the daily hydrocortisone dose and prevalence of maladaptive personality traits (i.e. identity problems, cognitive distortion, compulsivity, restricted expression, callousness, oppositionality, rejection, conduct problems, social avoidance, narcissism, and insecure attachment, all P<0.05). There was also a strong relation between the mean daily hydrocortisone dose and both psychological morbidity (i.e. depression, P<0.05) and QoL impairments (i.e. general health perception, several measures of physical functioning, and vitality, all P<0.05).
  
  
  CONCLUSIONS
  Patients on stable glucocorticoid replacement therapy for PAI report psychological morbidity and impaired QoL. Psychological morbidity, impaired QoL, and maladaptive personality traits were all associated with higher dosages of hydrocortisone.
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands c.d.andela@lumc.nl.
authors.forename: Cornelie D
authors.initials: CD
authors.lastname: Andela
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.affiliation: Department of Endocrinology and MetabolismC7-Q, Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsPsychological ScienceUniversity of California Merced, Merced, California, USADepartment of Medical PsychologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment of MedicineAcademic Medical Center, Amsterdam, The NetherlandsDepartment of PsychiatryLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
mesh_terms: D000224:Addison Disease / Q000188:drug therapy / Q000523:psychology*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010551:Personality; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D005438:Fludrocortisone; D006854:Hydrocortisone