MANAGEMENT OF ENDOCRINE DISEASE: Quality of life tools for the management of pituitary disease

Abstract

Background In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. Objective To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases. Design Critical review of the pertinent literature and pragmatic discussion of available information. Methods Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis. Results QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing’s disease (similar to other causes of Cushing’s syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine ‘cure’, scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated. Conclusions To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.