, Volume 19, Issue 6, pp 590–600 | Cite as

Coping strategies have a strong impact on quality of life, depression, and embitterment in patients with Cushing’s disease

  • Sonja Siegel
  • Monika Milian
  • Bernadette Kleist
  • Tsambika Psaras
  • Maria Tsiogka
  • Dagmar Führer
  • Maria Koltowska-Häggström
  • Jürgen Honegger
  • Oliver Müller
  • Ulrich Sure
  • Christa Menzel
  • Michael Buchfelder
  • Ilonka Kreitschmann-Andermahr



Quality of life (QoL) and psychosocial well-being are substantially impaired in patients with Cushing’s disease (CD), not only at the acute illness stage but also after therapy; however, the reason for these impairments remains unclear.


In this cross-sectional, patient-reported outcome study, we conducted a postal survey on psychosocial impairment and coping strategies in patients after surgical treatment of CD in three large tertiary referral centers. In total, 176 patients with CD completed a compilation of self-assessment inventories pertaining to depression (Hospital Anxiety and Depression Scale, HADS), QoL (Short Form SF-36, Tuebingen CD; Tuebingen CD-25), coping style (Freiburg questionnaire on coping with illness, FKV-LIS), and embitterment (Bern Embitterment Inventory), on average 6.8 ± 6.66 years after surgery. Regression analyses were performed to identify predictors of psychosocial impairment.


At the time of the study, 21.8 % of patients suffered from anxiety, 18.7 % experienced an above-average feeling of embitterment, and 13.1 % suffered from depression. Maladaptive coping styles (FKV-LIS subscales depressive coping and minimizing importance) emerged as robust and strong predictors of psychosocial impairment in all inventories; while age, sex, and hydrocortisone intake failed to explain the variance in these measures.


Similar to several studies in non-pituitary patient cohorts (e.g., patients with multiple sclerosis or lower back pain), our results indicate that psychosocial impairment in CD is significantly influenced by how the patient deals with the illness. Therefore, psychological training of positive coping styles could be a helpful complementary therapy in the overall treatment strategy of CD.


Cushing’s disease Coping skills Coping behavior Quality of life Depression 



Editorial support and linguistic corrections were provided by Anna Bagińska M.Sc. and Julia Archbold, Ph.D. from Proper Medical Writing Sp. z o.o., Poland.


This work was supported by an independent investigator-initiated grant by Novartis Germany (Project Number RSIG-23).

Author contributions

Kreitschmann-Andermahr, T. Psaras, M. Milian, S. Siegel, M. Buchfelder designed the study. S. Siegel, B. Kleist, C. Menzel and I. Kreitschmann-Andermahr performed the study and other authors contributed with the data. I. Kreitschmann-Andermahr, S.Siegel and B. Kleist analysed the data. All co-authors took active part in the interpretation of results. S. Siegel, I. Kreitschmann-Andermahr and M. Kołtowska-Häggström wrote the first version of the manuscript. All co-authors participated in the preparation of the manuscript and revised its each version. All co-authors accepted the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

S. Siegel, M. Milian, T. Psaras, M. Tsiogka, D. Führer-Sakel, J. Honegger, C. Menzel, M. Buchfelder and I. Kreitschmann-Andermahr have received research and/or travel grants and/or speaker honoraria from Novartis Pharma. M. Kołtowska-Häggström is a consultant for Strongbridge Biopharma. The other authors report no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sonja Siegel
    • 1
    • 5
  • Monika Milian
    • 2
  • Bernadette Kleist
    • 1
  • Tsambika Psaras
    • 2
  • Maria Tsiogka
    • 3
  • Dagmar Führer
    • 3
  • Maria Koltowska-Häggström
    • 4
  • Jürgen Honegger
    • 2
  • Oliver Müller
    • 1
  • Ulrich Sure
    • 1
  • Christa Menzel
    • 5
  • Michael Buchfelder
    • 5
  • Ilonka Kreitschmann-Andermahr
    • 1
  1. 1.Department of NeurosurgeryUniversity of Duisburg-EssenEssenGermany
  2. 2.Department of NeurosurgeryUniversity of TuebingenTuebingenGermany
  3. 3.Department of Endocrinology and Metabolic DiseasesUniversity of Duisburg-EssenEssenGermany
  4. 4.Department of Women’s and Children’s HealthUppsala UniversityUppsalaSweden
  5. 5.Department of NeurosurgeryUniversity of Erlangen-NurembergErlangenGermany

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