title: Health-related quality of life of patients with hypothalamic-pituitary-adrenal axis dysregulations: a cohort study.
abstract: OBJECTIVE
  Health-related quality of life (HrQoL) is increasingly considered to be an important outcome of care for hypothalamic-pituitary-adrenal (HPA) axis dysregulation. The objective of this study was to assess the influence of type of HPA axis dysregulation and cortisol status on HrQOL and its evolution with time and treatment.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Between September 2007 and April 2014, HrQoL questionnaires were administered during routine management to all patients with HPA axis dysregulation hospitalized in a single department, and this was repeated after 6- 12-, 24- and 36-month during standard follow-up. The Medical Outcomes Study 36-item short-form health survey (SF-36) and the General Health Questionnaire 12 (GHQ-12) were used simultaneously, with a common time schedule to measure the impact of HPA axis dysregulation on HrQoL. Multivariate mixed linear regression models were constructed to adjust for potential confounders.
  
  
  RESULTS
  343 patients (206 with Cushing's syndrome of pituitary origin, 91 with Cushing's syndrome of adrenal origin and 46 with Addison's disease) responded to the questionnaires. Overall, HrQoL scores were well below population values. Cushing syndrome of pituitary origin was associated with worse HrQoL, especially in physical dimensions. More than half of the patients, of all diagnoses and cortisol status, had psychological distress requiring attention according to the GHQ-12. Hypercortisolism had the greatest negative influence on HrQoL.
  
  
  CONCLUSIONS
  HRQoL appears significantly altered by all forms of HPA axis dysregulation, and most substantially and broadly by Cushing's syndrome, notably during periods of hypercortisolism. These effects on HRQoL deserve further consideration both in clinical practice and research.
authors.affiliation: Center for Rare Adrenal DiseasesEndocrinology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: De Bucy
authors.affiliation: Center for Rare Adrenal DiseasesEndocrinology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guignat
authors.affiliation: Center for Rare Adrenal DiseasesEndocrinology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Tanya
authors.initials: T
authors.lastname: Niati
authors.affiliation: Center for Rare Adrenal DiseasesEndocrinology Department, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France.|INSERM U1016Institut Cochin, Paris, France.|Université Paris DescartesSorbonne Paris Cité, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bertherat
authors.affiliation: Université Paris DescartesSorbonne Paris Cité, Paris, France.|Biostatistics and Epidemiology UnitHôtel Dieu, AP-HP, Paris, France.|EA 4360 (APEMAC)Paris, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Coste
mesh_terms: D000224:Addison Disease / Q000503:physiopathology / Q000523:psychology*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone