Quality-of-Life Recovery in Cushing's Disease: A Cluster Analysis

Successful surgery for Cushing's disease (CD) leads to an abrupt change in cortisol levels, and patients often experience symptoms that can adversely affect their quality of life (QOL). The goal of this study was to provide a detailed characterization of the changes in QOL before and after successful surgery.

The QOL-CD, a CD-specific questionnaire, was administered at routine clinical visits during active disease prior to surgery and during the early postoperative phase following successful surgery. Descriptive statistics and nonparametric tests characterized clinical, endocrinological, and ophthalmological attributes at both phases. Euclidean hierarchical clustering of the 34 patients who completed both pre- and postoperative questionnaires identified latent subgroups of QOL change.

In the cohort as a whole, hypertension (OR = 0.31, p = .003), emotional health (p = .026) and physical health (p < .001) improved following treatment. Changes in emotional health were correlated with changes in mental status (r = 0.66, p < .001) and social well-being (r = 0.53, p = .001). The cluster analysis revealed five distinct patterns of pre- to postoperative changes in QOL domains, grouped into three categories based on severity. Group 1 (n = 5) patients showed worsening in most domains of QOL, Group 2 (n = 20) showed marginal changes in QOL and Group 3 (n = 9) demonstrated improvements across all QOL domains.

Our results highlight the need to educate and support patients before and after surgery for CD. Long-term follow-up studies are needed to better understand the trajectory of QOL recovery and to identify predictors of treatment response.