***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The European Registry on Cushing 's syndrome ( ERCUSYN ) is design ed to collect prospect i ve and follow-up data at EU level on Cushing 's syndrome ( CS ) . DESIGN AND METHODS Baseline data on 481 CS patients ( 390 females , 91 males ; mean age ( ±s.d . ) : 44±14 years ) collected from 36 centres in 23 countries , including new patients from 2008 and retrospective cases since 2000 . Patients were divided into four major aetiologic groups :  pituitary-dependent  CS ( PIT-CS ) ( 66 % ) , adrenal-dependent CS ( ADR-CS ) ( 27 % ) , CS from an ectopic source ( ECT-CS ) ( 5 % ) and CS from other aetiologies ( 2 % ) . RESULTS Proportion of men in the ECT-CS group was higher than in the other groups ( P<0.05 ) . The ADR-CS group was older than the PIT-CS ( P<0.05 ) . Prevalence of hirsutism ( 92 % ) and diabetes ( 74 % ) in ECT-CS was higher than in the other groups ( P<0.05 and P<0.01 respectively ) . PIT-CS had more skin alterations , menstrual irregularities and hirsutism than ADR-CS ( P<0.01 ) . Reduced libido was more prevalent in men than women ( P<0.01 ) . Prevalence of spine osteoporosis was higher in men than women ( P<0.05 ) , and males had more vertebral and rib fractures than females ( 52 vs 18 % for vertebrae ; P<0.001 and 34 vs 23 % for ribs ; P<0.05 ) . ECT-CS  consulted a diabetologist more frequently than ADR-CS ( P<0.05 ) , while a gynaecologist was consulted more often by women with PIT-CS or ADR-CS than with ECT-CS ( P<0.05 ) . Overall , weight gain was more common in women than men ( P<0.01 ) . CushingQoL and EuroQoL visual analogue scale scores did not differ between the groups . CONCLUSIONS The ERCUSYN project demonstrates a heterogeneous clinical presentation of CS at a European level , depending on gender and aetiology The aim of this study was to assess the effects of replacement with recombinant human growth hormone ( rhGH ) in patients with GH deficiency ( GHD ) after treatment of acromegaly . Intervention study . Sixteen patients ( 8 men , age 56 years ) , treated for acromegaly by surgery and radiotherapy , with an insufficient GH response to insulin-induced hypoglycaemia , were treated with 1 year of rhGH replacement . Study parameters were assessed at baseline and after 1 year of rhGH replacement . Study parameters were cardiac function , body composition , bone mineral density ( BMD ) , fasting lipids , glucose , bone turnover markers , and Quality of Life ( QoL ) . During rhGH replacement  IGF-I concentrations increased from −0.4 ± 0.7 to 1.0 ± 1.5 SD ( P = 0.001 ) , with a mean daily dose of 0.2 ± 0.1 mg in men and 0.3 ± 0.2 mg in women . Nonetheless , rhGH replacement  did not alter cardiac function , lipid and glucose concentrations , body composition or QoL. Bone turnover markers ( PINP and β crosslaps ) levels increased ( P = 0.005 and P = 0.021 , respectively ) , paralleled by a small , but significant decrease in BMD of the hip . The beneficial effects of rhGH replacement in patients with GHD during cure from acromegaly are limited in this study OBJECTIVE To develop and test the psychometric properties of a 25-item version of the National Eye Institute Visual Function Question naire ( NEI VFQ-25 ) . DESIGN Prospect i ve observational cohort study of persons with 1 of 5 chronic eye diseases or low vision who were scheduled for nonurgent visits in ophthalmology practice s and a reference sample of persons without eye disease . SETTING Eleven university-based ophthalmology practice s and the NEI Clinical Center . PATIENTS Eligible participants had to have 1 of the following eye conditions : age-related cataracts , age-related macular degeneration , diabetic retinopathy , primary open-angle glaucoma , cytomegalovirus retinitis , or low vision from any cause . Seven of the 12 sites also enrolled persons in a reference sample . Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error . All eligible persons had to be 21 years or older , English speaking , and cognitively able to give informed consent and participate in a health status interview . MEASUREMENTS AND MAIN RESULTS To provide the data needed to create the NEI VFQ-25  , all subjects completed an interview that included the 51-item NEI VFQ . Estimates of internal consistency indicate that the subscales of the NEI VFQ-25 are reliable . The validity of the NEI VFQ-25 is supported by high correlations between the short- and long-form versions of the measure , observed between-group differences in scores for persons with different eye diseases of varying severity , and the moderate-to-high correlations between the NEI VFQ-25 subscales that have the most to do with central vision and measured visual acuity . CONCLUSIONS The reliability and validity of the NEI VFQ-25 are comparable to those of the 51-item NEI VFQ field test version of the survey . This shorter version will be more feasible in setting s such as clinical trials where interview length is a critical consideration . In addition , preliminary analyses indicate that the psychometric properties of the NEI VFQ-25 are robust for the eye conditions studied ; this suggests that the measure will provide reproducible and valid data when used across multiple conditions of varying severity Objective To verify whether patients with pituitary disorders in remission and on appropriate treatment display significant differences in psychological distress compared to healthy controls and other patients treated for nonpituitary endocrine disorders OBJECTIVE Vali date the acromegaly quality of life ( AcroQoL ) question naire as a disease-generated question naire , which analyses physical and psychological domains , the latter subdivided into appearance and personal relationship sub-scales , to evaluate health-related quality of life ( HRQoL ) in acromegaly . DESIGN Prospect i ve , observational multicenter study . METHODS One hundred and six patients with acromegaly , 42 with active disease studied basally and 6 months after treatment ( ' sensitivity to change ' group ) , and 64 with treated , stable disease , studied twice within 1 month ( ' reliability ' group ) were included . As controls , a reference Spanish population ( n=12,245 for the EuroQoL question naire ) and 157 obese patients ( body mass index>30 kg/m2 ) were studied basally . Socio-demographic data , clinical activity , co-morbidity , GH , IGF-I , and HRQoL ( overall perception of health state , EuroQoL and AcroQoL in the obese controls and acromegalic patients ) were evaluated . RESULTS Globally , AcroQoL scored worse in the ' sensitivity to change ' group than in the ' reliability ' group ( 56+/-20 vs 65+/-18 , P<0.05 ) , but did not discriminate between patients and obese controls . The psychological domain was worse in the ' sensitivity to change ' group than obese controls ( P<0.05 ) . Appearance was the most affected sub-scale in acromegaly and significantly worse than in obese controls . The sub-scale personal relationships of AcroQoL were less affected in the ' reliability ' group than in obese controls ( P<0.05 ) . Patients with acromegaly and obese controls showed more problems on the EuroQoL than general Spanish population . Significant correlations were observed globally and for each dimension between AcroQoL and the generic question naires . On re-testing , no change was observed in the ' reliability ' group in any question naire , demonstrating good test-re-test reliability . In the ' sensitivity to change ' group after 6 months of treatment , there was improvement in the generic question naires and in AcroQoL score ( P<0.01 ) . Internal consistency of AcroQoL was good ( Cronbach 's alpha>0.7 ) . No correlation between AcroQoL and GH or IGF-I was observed . CONCLUSION AcroQoL question naire is a valid tool for the assessment of HRQoL in clinical practice in patients with acromegaly CONTEXT Cotreatment of acromegaly with pegvisomant and a somatostatin analog ( SA ) has proven feasible . Previous studies in the field have focused on patients with an insufficient response to SA monotherapy in whom pegvisomant was added without changing the SA dose . OBJECTIVE The objective of the study was to study whether patients sufficiently controlled on SA monotherapy can be transferred to combination therapy with low-dose pegvisomant and a reduced SA dose . DESIGN Eighteen acromegalic patients well controlled on SA monotherapy , mean ± se aged 54 ± 3 yr , were r and omized in a parallel study over 24 wk to unchanged SA monotherapy or cotreatment with pegvisomant ( 15 - 30 mg twice a week ) and SA ( half the usual dosage ) . SETTING This was an investigator-initiated study in a single tertiary referral center . MAIN OUTCOME MEASURES Glucose tolerance , substrate metabolism , insulin sensitivity , body composition , and quality of life were measured . RESULTS Median pegvisomant dose was 52.5 mg/wk ( range 30 - 60 ) . IGF-I ( micrograms per liter ) was comparable both at baseline ( P = 0.88 ) and after 24 wk of treatment ( P = 0.48 ) . The change in IGF-I between baseline and wk 24 also did not differ between groups ( P = 0.15 ) . Apart from increased peak insulin levels during the oral glucose tolerance test in the cotreatment group , no substantial differences between the two groups were detected . Moderately elevated liver enzymes were found in 17 % of the patients on pegvisomant therapy . CONCLUSION Acromegalic patients well controlled on SA monotherapy can maintain safe IGF-I levels during 24 wk of cotreatment with low-dose pegvisomant and a 50 % reduced SA dose . This treatment modality , however , does not seem to provide significant benefits for the patients Background There is a paucity of research about health-related quality of life ( HRQL ) among adolescents , as studies have to a large extent focused on adults . The main aim was to provide information for future studies in this growing field by presenting normative data for the Short Form 36 ( SF-36 ) and the Hospital Anxiety and Depression Scale ( HADS ) for Swedish adolescents and young adults . Additionally , the influence of age and gender , as well as method of administration , was investigated . Methods A sample of 585 persons aged 13–23 was r and omly chosen from the general population , and stratified regarding age group ( young adolescents : 13–15 years ; older adolescents : 16–19 years , and young adults : 20–23 years ) and gender ( an equal amount of males and females ) . Within each stratum , the participants were r and omized according to two modes of administration , telephone interview and postal question naire , and asked to complete the SF-36 and the HADS . Descriptive statistics are presented by survey mode , gender , and age group . A gender comparison was made by independent t-test ; and one-way ANOVA was conducted to evaluate age differences . Results Effects of age and gender were found : males reported better health-related quality of life than females , and the young adolescents ( 13–15 years old ) reported better HRQL than the two older age groups . The older participants ( 16–23 years old ) reported higher scores when interviewed over the telephone than when they answered a postal question naire , a difference which was more marked among females . Interestingly , the 13–15-year-olds did not react to the mode of administration to the same extent . Conclusion The importance of taking age , gender , and method of administration into consideration , both when planning studies and when comparing results from different groups , studies , or over time , is stressed The purpose of the study was to evaluate changes in general self-efficacy , health related quality of life ( HRQoL ) , and stress among patients with neuroendocrine tumors ( NET ) following a multidisciplinary educational intervention .  Forty-one patients were enrolled in this exploratory pilot study . A total of 37 patients completed the full 26-week intervention based on the principles of self-efficacy . General self-efficacy was measured by the General Self-Efficacy Scale , HRQoL was measured with the SF-36 , and stress was measured with the Impact of Event Scale . Mixed effect models were used to evaluate changes in general self-efficacy , mental and physical components of HRQoL , and stress adjusting for demographic and clinical variables . Results showed significant improvements in patients ' general self-efficacy ( β = 0.71 ; P < 0.05 ) , physical component scores of HRQoL ( β = 3.09 ; P < 0.01 ) , and stress ( β = −2.10 , P = 0.008 ) . Findings suggest that patients with NET have the capacity to improve their ability to cope with their disease , problem- 
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QoL was found to be impaired in patients with active disease relative to controls , and generally improved during biochemical cure .
Intervention studies ( predominantly evaluating medical interventions ) have been found to improve QoL. Conclusions The growing number of studies assessing QoL generally described the negative impact of pituitary adenomas .
Surgical and pharmacological interventions improve but not normalize QoL. We postulate that there might be margin for further improvement of QoL , for instance by using psychosocial interventions , in addition to optimal medical treatment