Long-term health-related quality of life of surgically treated pituitary adenoma patients: a descriptive study

Abstract

Context. The literature concerning the health-related quality of life (HRQoL) of patients with surgically treated PA is controversial. Objective. To describe the long-term HRQoL of surgically treated patients in all PA classes. Design and subjects. The 15D, a generic HRQoL instrument producing a 15-dimensional profile and a single 15D index score (a difference ≥0.03 on a 0-1 scale is considered clinically important), was used to assess the HRQoL of a 13-year surgical cohort of PA patients in Northern Finland. Results and Conclusion. Nighty-eight eligible consecutive patients with surgically treated PA were studied at an average of 6.3 years after their latest pituitary operation. The average postoperative 15D profiles in patients with non-functioning PA and in acromegalics without GH-suppressive medical treatment were similar to those of the age-standardized general population. However, after this rather long followup, the mean 15D score and the number of statistically significant 15D dimension impairments, compared with those of their reference population, were 0.11 and 9/15, 0.10 and 3/15, and 0.08 and 7/15 for Cushing's disease, acromegalics needing somatostatin analog, and prolactinoma patients, respectively. Hypopituitarism with replacement medication was not associated with impaired HRQoL. The somatostatin-analog-associated HRQoL finding warrants further clinical research.

Figure 1

Mean 15D dimension values of Cushing syndrome patients (ACTH). The multiple statistically significant impairments in 15D dimensions are presented by an asterisk (*, P < 0.05) compared to the reference population (Ref. popul.). The mean 15D score of the ACTH group was significantly lower than that of the Ref. popul. (keybox). Abbreviations used: Move: moving, See: seeing, Hear: hearing, Breath: breathing, Sleep: sleeping, Eat: eating, Elim: eliminating, Uact: usual activities, Mental: mental functioning, Disco: discomfort, Depr: depression, Distr: Distress, Vital: vitality, Sex: sexual function.

Figure 2

Mean 15D dimension values of acromegalic patients (GH-all). There was a statistical decrease in moving and vitality dimensions and the 15D score (keybox) compared to the reference population (Ref. popul.). Males (♂ symbol at the gender-specific mean of the particular dimension) had a significantly lower value in the depression and distress dimensions than did females (♀ symbol, resp.). 15D abbreviations are the same as in Figure 1. (*, P < 0.05).

Figure 3

Mean 15D dimension values of acromegalic patients grouped by need for SSA treatment at the time of the questionnaire. When in remission (GH remis.), all the 15D dimension values were comparable to the reference population (Ref popul.). In contrast, acromegalics with SSA treatment (GH medic.) had significantly more discomfort and distress in addition to decreased vitality and the 15D score (keybox) compared to the Ref. popul. 15D abbreviations are the same as in Figure 1. (*, P < 0.05) acromegalics on SSA treatment versus Ref. popul.

Figure 4

Mean 15D dimension values of prolactinoma patients (PRL). There was a statistical decrease in sleeping, usual activities, mental functioning, depression, vitality, and sexual function dimensions and in the 15D score (keybox) compared to the reference population (Ref. popul.). Males (♂, symbol at the gender-specific mean of mental dimension) had a significantly lower score in mental functioning than did females (♀, symbol resp.), but previous irradiation may be a confounding factor here (see text). The 15D abbreviations are the same as in Figure 1. (*, P < 0.05).

Figure 5

Mean 15D dimension values of NF adenoma patients (NF). There was no statistical difference in any of the 15D dimensions or in the 15D score (keybox) compared to the reference population (Ref. popul.). The 15D abbreviations are the same as in Figure 1.