title: Quality of life (QoL) impairments in patients with a pituitary adenoma: a systematic review of QoL studies.
abstract: OBJECTIVE
  Pituitary adenomas give rise to physical and psychological symptoms, which may persist after biochemical cure. Growing attention has been paid to quality of life (QoL) in these patients. We aimed to systematically analyze QoL assessment methods and QoL outcome in these patients.
  
  
  METHODS
  We conducted a systematic literature search up to January 2014 in PubMed, Web of Knowledge, PsycInfo and EMBASE.
  
  
  RESULTS
  102 papers assessing QoL in patients with a pituitary adenoma were included. In clinical (original) studies in which QoL was the primary outcome parameter (n = 54), 19 studies combined a generic questionnaire with a disease-specific questionnaire. QoL was found to be impaired in patients with active disease relative to controls, and generally improved during biochemical cure. However, no normalization occurred, with patients with remitted Cushing's disease demonstrating the smallest improvement. Somatic factors (e.g., hypopituitarism, sleep characteristics), psychological factors (illness perceptions) and health care environment (rural vs. urban) were identified as influencing factors. Intervention studies (predominantly evaluating medical interventions) have been found to improve QoL.
  
  
  CONCLUSIONS
  The growing number of studies assessing QoL generally described the negative impact of pituitary adenomas. QoL research in this patient group could be further elaborated by the development of disease-specific questionnaires for prolactinoma and non-functioning adenoma, consequent use of generic and disease-specific questionnaires and using a long-term (longitudinal) follow-up. Surgical and pharmacological interventions improve but not normalize QoL. We postulate that there might be margin for further improvement of QoL, for instance by using psychosocial interventions, in addition to optimal medical treatment.
authors.affiliation: Division of Endocrinology and Center for Endocrine Tumors Leiden, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands, c.d.andela@lumc.nl.
authors.forename: Cornelie D
authors.initials: CD
authors.lastname: Andela
authors.forename: Margreet
authors.initials: M
authors.lastname: Scharloo
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
authors.forename: Ad A
authors.initials: AA
authors.lastname: Kaptein
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D017281:Cost of Illness; D006801:Humans; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires