Coping strategies less effective in patients with pituitary adenomas

Issue: March 2011

Patients who are treated for Cushing’s disease, acromegaly or nonfunctioning pituitary macroadenomas appear to have different and less effective coping strategies than healthy people.

Coping strategies are used by patients when in situations that require adjustments, such as dealing with an adverse event or an illness and its treatment. The ways in which a patient utilizes coping strategies may have an effect on medical outcomes and overall quality of life.

“Knowledge on coping strategies used by these patients is of importance, because this information can be used in designing an intervention based on, for example, cognitive behavioral therapy, self-management training and information on the negative effects of the disease,” researchers from Leiden University Medical Center in the Netherlands, wrote in the Journal of Endocrinology & Metabolism.

Exploring coping strategies

The researchers conducted a cross-sectional study that included patients who were treated for Cushing’s disease (n=42), acromegaly (n=80) or nonfunctioning pituitary microadenomas (n=61). Patients with Cushing’s disease had been treated by transsphenoidal surgery, possibly followed by repeat surgery or postoperative radiotherapy. Patients with acromegaly were in remission or were biochemically controlled. Patients with nonfunctioning pituitary macroadenomas were treated with surgery, and all study patients were free of recurrence.

All patients filled out a questionnaire on coping strategies. They were scored using the Utrecht Coping List, a Dutch coping scale that uses 47 statements and a four-point scale was used to analyze patients’ coping strategies. Scores may vary from active coping to avoiding to seeking social support.

Before this study, the coping strategy of these patients had not been studied.

Compared with a group of 712 people from Dutch population, patients who were treated for pituitary adenomas had lower scores on active coping and seeking social support, and higher scores on the avoiding scale. Compared with a group of 59 Dutch patients with chronic pain, patients with pituitary adenomas scored higher on seeking social support. Compared with a group of 525 patients receiving primary care psychology services, patients with pituitary adenomas scored lower on avoiding, seeking social support, passive coping and expressing emotion. Patients with nonfunctioning pituitary macroadenomas were less likely to seek social support compared with patients with Cushing’s disease.

“This indicates that patients treated for pituitary adenomas report less effective coping strategies compared with the normal population but apparently use more effective coping strategies than patients with chronic pain and patients in primary care psychology services,” the researchers wrote.

Further analysis revealed that when compared with each other, patients after treatment for Cushing’s disease, acromegaly and nonfunctioning pituitary macroadenomas did not differ in their coping strategies; patients with Cushing’s disease, however, were more likely to seek social support than patients with nonfunctioning pituitary macroadenomas.

“This is an interesting difference that might be due to more severe long-term effects of Cushing’s disease compared with nonfunctioning pituitary macroadenomas,” the researchers wrote.

Coping skills training

The results of this study “strongly point toward the need to develop, to apply and to evaluate coping skills training and self-management in patients with this condition,” according to the researchers. Patients with inflammatory bowel disease and those who suffer from a stroke are offered similar targeted interventions, they said.

“This might, in turn, improve their quality of life,” they concluded.

For more information:

Tiemensma J. J Clin Endocrinol Metab. 2011;doi:10.1210/jc.2010-2490.

Disclosure: The researchers report no relevant financial disclosures.