Abstract
Purpose To identify the characteristics of the physical and mental health status of patients with pituitary adenomas, explore the postoperative reversibility of impaired health status, and assess the impact of clinical characteristics, hormone levels, anxiety, depression, and disease stigma on health status. Methods We prospectively enrolled 147 and 138 patients with nonfunctioning and secretory pituitary adenomas, respectively. Health status was evaluated in 8 domains using the 36-item Short-Form Health Survey before and 3 months after transsphenoidal surgery. The Self-Rating Anxiety Scale, the Self-Rating Depression Scale, and the Stigma Scale for Chronic Illness were used to assess the psychological status. Results Compared with the healthy population reference values, general physical and mental health, social functioning, and role limitations due to physical and psychological health problems were all found to be significantly impaired in the adenoma patients. Health status was worse in patients with adrenocorticotropic hormone- (ACTH-) secreting and growth hormone- (GH-) secreting adenomas than in patients with nonfunctioning adenomas. Among the patients, 11.6% had anxiety and 30.9% had depression. Higher scores for anxiety, depression, and disease stigma; older age; higher body mass index; and tumor recurrence were independent risk factors for health status impairment in at least one domain. Physical function impairment and role limitations caused by physical health problems became worse after surgery, whereas the mental component of health status remained the same. Conclusion Health status was impaired in patients with pituitary adenomas, especially secretory adenomas. Physical function and role limitations were worse 3 months after surgery than before surgery. Mental problems, old age, obesity, and tumor recurrence reduced health status.
Highlights
Pituitary adenomas arise from the anterior pituitary gland and are the second most common primary central nervous system tumors [1]
Patients who had been treated with hormone replacement therapy before enrollment and had normal hormone levels were included. e criteria for patients with secretory adenomas were as follows: (1) a pituitary adenoma was evident on magnetic resonance imaging (MRI) and (2) at least one hormone was above the normal range and in accordance with the endocrine diagnostic standard for the corresponding secretory pituitary adenoma [2, 16,17,18,19]. e exclusion criteria were as follows: (1) the patient refused to participate in the study, (2) the patient had difficulty finishing the evaluation, and (3) there were potential tumors in other organs that could have influenced the evaluation of health status
In the secretory adenoma group, growth hormone- (GH-)secreting adenomas (66, 47.8%), adrenocorticotropic hormone- (ACTH-)secreting adenomas (35, 25.4%), prolactinomas (24, 17.4%), thyroid-stimulating hormone (TSH)-secreting adenomas (8, 5.8%), follicle-stimulating hormone (FSH)-secreting adenomas (1, 0.7%), and GH/PRL-secreting adenomas (4, 2.9%) were clinically identified and confirmed by pathologists using immunohistochemistry. e psychiatric status evaluation showed that 33 patients (11.6%) had anxiety and 88 patients (30.9%) had depression. e average score of disease stigma was 35.6 ± 14.0 points
Summary
Pituitary adenomas arise from the anterior pituitary gland and are the second most common primary central nervous system tumors [1]. With the elimination of tumor mass effects and the mitigation of elevated hormone levels, the reduced quality of life in patients with pituitary adenomas was reported to be reversed in some literature [9,10,11]. Health-related quality of life, or health status, can be evaluated by the 36-item Short-Form Health Survey (SF-36), which comprises both a physical component and a mental component [12]. Tanemura et al [11] evaluated the health status of 30 patients with nonfunctioning macroadenomas using the SF-36 questionnaire and found that scores on the mental component were increased at 1 month after surgery and remained stable at 6 months, whereas the physical summary scores were initially decreased at 1 month and recovered to normal levels by 6 months after surgery. 6 weeks, 6 months, and 1 year after treatment are used as time points used to evaluate the reversibility of reduced health status [9,10,11], but the effects at 3 months after treatment, which is an important time point for surgeons, have not been well evaluated
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