Prospective Assessment of Mood and Quality of Life in Cushing Syndrome Before and After Biochemical Control

Oct 30, 2025The Journal of clinical endocrinology and metabolism

Mood and quality of life before and after hormone control in Cushing syndrome

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Abstract

Treatment for Cushing syndrome resulted in improvements in quality of life and mood metrics after a mean follow-up of 2.3 years.

Quality of life improved by an average of 18.2 points, with 64.6% of patients achieving a minimal important difference.
Depression scores decreased by 6.8 points, with 67.9% of patients reaching a clinically meaningful improvement.
Anxiety levels dropped by 9.6 points for state anxiety and 8.6 points for trait anxiety, with minimal important differences achieved by 53.2% and 52.8% of patients, respectively.
Predictors of quality of life improvement included lower baseline BMI, symptoms lasting less than 3 years, and normal follow-up late-night salivary cortisol levels.
Younger age and more than 6 months of post-operative hydrocortisone replacement were associated with greater anxiety improvements.

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CONTEXT: Cushing syndrome (CS) impairs quality of life (QoL) and mood. Prospective real-life data on post-treatment recovery and predictors of improvement are limited.

OBJECTIVES: Evaluate changes in QoL, depression, and anxiety in patients with CS, before and after biochemical control, and identify predictors of clinically meaningful improvement.

DESIGN AND SETTING: Prospective observational study at a tertiary center.

PATIENTS: 67 patients with endogenous CS (60 pituitary, 7 adrenal) were assessed with active disease and again after achieving biochemical control through surgery and/or medication.

OUTCOMES: Patient-reported outcomes included CushingQoL, Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI).

RESULTS: Mean and longest follow-up was 2.3 and 11.5 years, respectively. Treatment led to improvements in mean scores across all domains (QoL: +18.2±20.9, BDI: -6.8±8.6, STAI-State: -9.6±12.5, STAI-Trait: -8.6±12.6; all p < 0.001). However, minimal important difference was achieved in 64.6% for QoL, 67.9% for BDI, 53.2% and 52.8% for STAI subscales. After multivariable analysis, QoL improvements were predicted by lower baseline BMI, pre-treatment symptoms <3 years, post-operative hydrocortisone replacement >6 months, and normal follow-up late-night salivary cortisol (LNSC). Depression improvements were predicted by symptoms <3 years, normal follow-up LNSC, and surgical treatment. Anxiety improvements were predicted by younger age and >6 months post-operative hydrocortisone. Depression improved more gradually than QoL and anxiety.

CONCLUSIONS: Although effective treatment improves mood and QoL in CS, clinically meaningful recovery is variable and incomplete for some patients. Our findings highlight the need to limit diagnostic delay and provide comprehensive post-treatment care that includes normalization of cortisol circadian rhythm.

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Prospective Assessment of Mood and Quality of Life in Cushing Syndrome Before and After Biochemical Control

Abstract

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