目的:一些研究强调了垂体瘤患者的心理和神经心理困难以及健康相关生活质量(HRQOL)的潜在降低,尽管激素缺乏或过量。就作者所知,这项研究是第一个前瞻性纵向病例对照研究,旨在同时测试HRQOL和精神和神经心理残疾是否与皮质醇增多症本身导致的神经功能障碍有关,库欣病(CD)患者的肿瘤肿块和/或手术。作者评估了神经外科手术前后CD和无功能垂体腺瘤(NFPA)患者的同质队列,并将这些患者与健康对照进行了比较。
方法:使用3份经过验证的问卷(SF-36,贝克抑郁量表-II[BDI-II],对20例患者(NFPA患者10例,CD患者10例)进行了评估。和明尼苏达州多相人格量表-II[MMPI-II]),以评估术前和神经外科术后12个月的HRQOL和心理状况。术前评估神经心理学测试,术后3-7天,术后12个月。招募了20名健康匹配的对照。
结果:术前,根据SF-36评分,NFPA和CD亚组的HRQOL评分比对照组差,尽管NFPA亚组在术后12个月出现了显著的恢复.术前,根据BDI-II和MMPI-II,CD患者有抑郁症状,术后持续12个月,连同社会内向和软骨病;NFPA患者与对照组相似,除了软骨病评分在所有时间点都具有临床意义.术前和术后3-7天,与对照组相比,两个亚组都表现出明显的神经心理障碍,但随着时间的推移,只有CD亚组没有完全恢复。
结论:在所有患者的早期时间点均观察到HRQOL和神经心理障碍,独立于皮质醇增多症,肿瘤块,手术成功.随着时间的推移,CD患者表现出持续的HRQOL变化,特别是在社会活动中。在这种情况下,与NFPA相比,CD似乎对HRQOL有很大影响,并且与更多的心理和神经心理合并症相关。
Some studies have highlighted psychological and neuropsychological difficulties and a potential reduction in health-related quality of life (HRQOL) in patients with pituitary tumors, despite hormone deficits or excess. To the authors\' knowledge, this
study is the first prospective longitudinal case-control
study with the aim of simultaneously testing whether HRQOL and psychiatric and neuropsychological disabilities are related to neural dysfunction due to hypercortisolism per se, or tumor mass and/or surgery in patients with Cushing\'s disease (CD). The authors evaluated a homogeneous cohort of patients with CD and nonfunctioning pituitary adenomas (NFPAs) before and after neurosurgery and compared these patients with healthy controls.
Twenty patients (10 with NFPA and 10 with CD) were evaluated using 3 validated questionnaires (SF-36, Beck Depression Inventory-II [BDI-II], and Minnesota Multiphasic Personality Inventory-II [MMPI-II]) to assess HRQOL and psychological status preoperatively and 12 months after neurosurgery. Neuropsychological tests were assessed preoperatively, 3-7 days postoperatively, and 12 months postoperatively. Twenty healthy matched controls were recruited.
Preoperatively, the NFPA and CD subgroups had worse HRQOL scores than controls on the basis of SF-36 scores, although the NFPA subgroup experienced significant recovery 12 months postoperatively. Preoperatively, CD patients had depressive symptoms according to the BDI-II and MMPI-II that persisted 12 months postoperatively, together with social introversion and hypochondriasis; NFPA patients were similar to controls except for hypochondriasis scores that were clinically significant at all timepoints. Preoperatively and 3-7 days postoperatively, both subgroups showed significant neuropsychological disabilities compared with controls, but only the CD subgroup did not completely recover over time.
HRQOL and neuropsychological impairments were observed in all patients at early timepoints, independent of hypercortisolism, tumor mass, and successful surgery. Over time, CD patients showed persistent changes in HRQOL, in particular in social activities. In this light, CD seems to have a strong impact on HRQOL and to be associated with more psychological and neuropsychological comorbidities than NFPA.