Objective: Cushing's syndrome (CS) is associated with neuropsychological deficits. As the cerebellum plays a key role in neuropsychological functions it may be affected in CS. The aim of this study was to investigate whether patients with CS have a smaller cerebellar volume than healthy controls, and to analyse whether cerebellar volume is associated with neuropsychological performance and clinical parameters.Design: A cross-sectional study was performed.Methods: Thirty-six CS patients (15 with active CS and 21 with CS in remission) and 36 controls matched for age, sex, and education underwent neuropsychological testing, quality of life assessment, clinical evaluation, and magnetic resonance imaging brain scan. Cerebellar volumes (white matter and cortex, bilateral) were calculated using FreeSurfer Software.Results: Patients with active CS showed smaller bilateral cerebellar cortex volumes than controls (left,P=0.035 and right,P=0.034), as well as a trend toward smaller right cerebellar cortex volumes than patients in remission CS (P=0.051). No differences were observed in the volume of cerebellar white matter between the three groups. Both right and left cerebellar cortex volumes correlated negatively with triglyceride levels (right:r=−0.358,P=0.002 and left:r=−0.317,P=0.005) and age at diagnosis (right:r=−0.433,P=0.008 and left:r=−0.457,P=0.005). Left cerebellar cortex volume also correlated positively with visual memory performance (r=0.245,P=0.038). Right cerebellar cortex volume positively correlated with quality-of-life scores (r=0.468,P=0.004).Conclusions: The cerebellar cortex volume is smaller in active CS patients than in controls. This finding is associated with poor visual memory and quality of life and is mostly pronounced in patients with higher triglyceride levels and older age at diagnosis.

Objective: To evaluate health-related quality of life (HRQoL) in Cushing's syndrome (CS) with the disease-generated CushingQoL questionnaire and to confirm its psychometric properties of test–retest reliability and sensitivity to change.Design: Clinical practice conditions in a tertiary referral center.Methods: The CushingQoL and EuroQoL questionnaires were administered at baseline and during follow-up and correlated with clinical parameters in 59 patients with CS. To check test–retest reliability, stable patients (either biochemically cured or with active hypercortisolism) were evaluated twice. To investigate sensitivity to change, new patients were evaluated at diagnosis and twice more following improvement after successful surgery.Results: At baseline, patients with active disease scored lower (indicating worse HRQoL) than those cured on the CushingQoL (46±14 vs 58±20,P<0.05) but not on the EuroQoL-visual analog scale (VAS; 64±20 vs 70±16,PNS). Test–retest reliability of CushingQoL was confirmed in stable patients, both in the ‘cured group’ (intraclass correlation coefficient (ICC)=0.78,n=34) and in the ‘active group’ (ICC=0.66,n=14). Sensitivity to change was confirmed in the ‘improvement group’ (n=11), as the CushingQoL score increased 4±1.5 and 9±3 months after surgery (P<0.01 and <0.001 respectively); the EuroQoL-VAS only improved after 9±3 months (P<0.01). Effect sizes were 1.02 and 1.86 for CushingQoL at 4±1.5 and 9±3 months respectively. Finally, scores of both questionnaires were correlated (r=0.504;P<0.001).Conclusions: The CushingQoL questionnaire shows good test–retest reliability and sensitivity to change in clinical practice conditions.

Cushing's disease (and by extension, Cushing's syndrome) is a rare disease due to a chronic cortisol excess, which usually has an important impact on quality of life (QoL). It can lead to numerous comorbidities that can interfere with daily life, as fatigability, myopathy, bone loss and fragility, increased cardiovascular risk, depression, and cognitive alterations. Of note, psychological alterations (including depression and anxiety) occur often, and are an important determinant of impaired quality QoL. QoL scores using different questionnaires are poorer in comparison to healthy controls, other pituitary adenomas and some chronic diseases. Even if some improvements can be observed after successful treatment, recovery does not seem to be complete, and comorbidities persist. This persistent QoL impairment has been found using both generic and disease-specific QoL questionnaires, and is also reported by the patients themselves, when asked directly. Multidisciplinary teams are essential to improve patients' well-being. Clinicians should take into account the whole scope of clinical problems and address the different comorbidites associated with the disease. Screening in the psychological sphere, with further intervention if necessary, can be helpful in the management of these patients. Interventions and programs have shown promising results, although there is a need for further development of new strategies for the benefit of these patients.

Background: Intensive care unit (ICU) patients can experience emotional distress and post‐traumatic stress disorder when they leave the ICU, also referred to as post‐intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient‐centred care and, ultimately, contribute to a positive experience.Aim: To describe the patients' experience while transitioning from the ICU to a general ward.Design: A descriptive qualitative study.Method: Data were gathered through in‐depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.Findings: Forty‐eight interviews were conducted. Impact on emotional well‐being emerged as a main theme, comprising four categories with six subcategories.Conclusion: Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well‐being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.Relevance to clinical practice: It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow‐up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.

Purpose of review Quality of life (QoL) is impaired in patients with pituitary tumors, even after biochemical cure. However, it is not usually assessed in daily practice. The aim of this study is to highlight recent findings on QoL in the different types of pituitary adenomas and hypopituitarism. Recent findings Patients with acromegaly or Cushing's syndrome have the greatest impairment of QoL, and concomitant hypopituitarism worsens it further. The use of disease-generated QoL questionnaires allows dimensions specifically affected in that disease to be addressed and these dimensions are more sensitive to change after successful therapy; in some cases, improvement in patients' sense of well-being has been shown despite no hormonal change, indicating that evaluation of QoL is not such a soft end-point as thought by some. Summary Systematic evaluation of QoL in patients with pituitary diseases provides information not always contemplated by hormonal and routine clinical evaluation; this allows detection of not often contemplated health problems, which may then be approached and treated, improving the care provided to these patients.

Cushing’s syndrome (CS) is a rare endocrine disease, due to cortisol hypersecretion. CS patients have comorbidities, often still present after biochemical cure. Specific nursing healthcare programs to address this disease and achieve improved health related quality of life (HRQoL) are lacking. Thus, an educational nursing intervention, through the development and promotion of specific educational tools, appears to be justified. The objective of this study is to assess the effectiveness of an educational nursing program in CS patients on HRQoL, clinical parameters, level of pain and physical activity, patterns of rest, and use of health resources. A prospective, randomized study was conducted in two reference hospitals for CS. Sixty-one patients (mean age 47 ± 12.7 years, 83.6 % females) were enrolled and divided into 2 groups: an “intervention” group where educational sessions were performed over 9 months and a “control” group, without these sessions. Specific questionnaires were used at the beginning and end of the study. After educational sessions, the intervention group had a better score in the CushingQoL questionnaire (p < 0.01), reduced level of pain (p < 0.05), improved physical activity (p < 0.01) and healthy lifestyle (p < 0.001) compared to the control group. A correlation between the CushingQoL score and reduced pain (r = 0.46, p < 0.05), improved physical activity (r = 0.89, p < 0.01), and sleep (r = 0.53, p = 0.01) was observed. This educational nursing program improved physical activity, healthy lifestyle, better sleep patterns, and reduced pain in CS patients, influencing HRQoL and reducing consumption of health resources. Moreover, the brief nature of the program suggests it as a good candidate to be used in CS patients.