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Adrenal insufficiency (AI) manifests as a clinical syndrome arising from either the direct impairment of adrenal glands, leading to primary AI characterized by deficiencies in glucocorticoids and mineralocorticoids, or adrenal cortex atrophy due to diminished adrenocorticotropic hormone (ACTH) stimulation, a consequence of hypothalamic and/or pituitary damage, resulting in secondary AI. The diagnosis of AI is based on clinical assessment and biochemical tests, including basal hormone level measurements and stimulation tests. In evaluating the results of laboratory tests, it is necessary to consider factors that may influence both pre-analytical and analytical phases, as well as the chosen methodology. Correct diagnosis of adrenal insufficiency and timely initiation of suitable replacement therapy are paramount. These steps are crucial not only for managing the condition but also to avert potentially life-threatening adrenal crises., Competing Interests: The authors report no conflicts of interest in this work.

Rabies is a viral disease that occurs in more than 150 countries worldwide. According to the World Health Organisation, this zoonotic disease causes an estimated 59 000 human deaths each year, with 95% occuring in Africa and Asia. The most common route of transmission is through the bite of an infected dog. The disease is preventable by vaccination, and effective prophylaxis is also available after animal bite injury. However, if the patient develops clinical signs, the disease is almost always fatal. The aim of this brief report is to summarise information on the global impact of rabies and to present the Zero by 30 strategy, which aims to achieve the elimination of human deaths due to rabies transmission from infected dogs by 2030.

Background: The SARS-CoV-2 pandemic represents one of the most challenging issues that have recently influenced everyday life in countries all over the world. Understanding the risk of this disease is of high importance in patients with multiple sclerosis (MS) as they represent a vulnerable population through their treatment with disease-modifying therapies (DMTs). Infective episodes may trigger relapses and lead to deterioration of the health condition., Summary: Vaccination is an important preventive measure against infectious diseases. In MS patients, concerns have been raised about the effectiveness of vaccines in patients on various immunomodulatory drugs and about their possible adverse effects including impairment of neurological functions. The objectives of this article were to summarize the current knowledge on immune responses to the COVID-19 vaccines and their safety in MS patients and to provide practical guidance based on the data available to date., Key Messages: Although MS is not associated with a higher risk of COVID-19, this infection can trigger relapses or pseudo-relapses. Vaccines against SARS-CoV-2 are recommended for all MS patients who are not in the active phase of the disease, despite the fact that there is still a lack of long-term reliable data on the effectiveness and safety of vaccines against COVID-19. Some DMTs can reduce vaccine humoral responses, but might still provide some protection and adequate T-cell response. To optimize the effectiveness of vaccination, the ideal timing of vaccine application and DMTs dosing regimen is crucial., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Malaria is one of the worlds most important infectious diseases, occurring in many tropical and subtropical countries. The causative agent is a parasitic protozoan of the genus Plasmodium, transmitted to humans by infected mosquitoes. More than 200 million people get malaria every year worldwide, and hundreds of thousands of them, mostly children under 5 years of age, die of it. Thanks to prevention programmes implemented by various organisations headed by the World Health Organisation (WHO) with the aim of eliminating malaria, cases have been declining in recent years. However, particularly in African countries, malaria continues to be a health and economic issue.

Germany's 2030-oral health agenda incorporates behavioral targets such as twice-daily toothbrushing and routine dental check-ups. Given the professional and social roles of dentists in oral health promotion, the oral health-related knowledge, attitudes, and behaviors (KAB) of dentists and dental students became worth investigation. The present study was designed as a descriptive cross-sectional study that aimed to evaluate oral health KAB of German dental students using the Hiroshima University - Dental Behavioral Inventory (HU-DBI). A total of 508 dental students filled in the questionnaire, out of which 74.2% were females, 38.8% were clinical students, 11.4% reported tobacco smoking at least once week, 26.6% reported drinking alcohol at least once a week, and 82.9% reported suffering from problematic internet use. The overall HU-DBI score was high (7.67 ± 1.32), and it was slightly higher among females (7.70 ± 1.33) than males (7.59 ± 1.29), and gender-diverse students (7.33 ± 1.37). Clinical students (7.88 ± 1.26) had a significantly higher HU-DBI score, especially in the domain of oral health behaviors, compared with preclinical students (7.53 ± 1.34). A significant improvement in oral health behaviors and HU-DBI score was found between the third- vs . the fourth year, which corresponds to the period when prophylaxis, hygiene, and periodontology courses are delivered. Tobacco smoking was significantly associated with poor oral health knowledge, behaviors, and overall HU-DBI score. Problematic internet use and alcohol drinking had slightly lower HU-DBI scores. The findings of the present study call for early implementation of preventive dentistry elements in German curricula and addressing oral health needs of gender minorities in Germany by future epidemiologic studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Riad, Buchbender, Howaldt, Klugar, Krsek and Attia.)

Dentists play a key role in the primary prevention of oral diseases and related systemic complications; therefore, their views on behavioural interventions need to be aligned with the current agendas for oral health. Likewise, dental students' oral health-related knowledge, attitudes, and behaviours (KAB) are of practical importance, as they are the future opinion leaders for oral health in their respective communities. A cross-sectional survey-based study was designed to evaluate the oral health KAB of dental students in both the Czech Republic and Slovakia. The study utilized translated versions of the Hiroshima University Dental Behavioural Inventory (HU-DBI), and it aimed to recruit students from all Czech and Slovak dental schools. A total of 487 students were included in this study, out of which 372 (76.4%) were females, 271 (55.6%) were enrolled in preclinical years, 68 (14%) reported smoking tobacco at least once a week, and 430 (88.3%) reported problematic internet use. The mean HU-DBI score of Czech and Slovak dental students (8.18 ± 1.80) was comparable with the previously reported scores of dental students in Nordic and Western European countries. Czech students (9.34 ± 1.29) had a significantly higher score than their Slovak counterparts (7.56 ± 1.73). In both countries, preclinical students (8.04 vs. 8.35), the students who reported tobacco smoking (7.63 vs. 8.27), and those who reported problematic internet use (8.11 vs. 8.70) had significantly lower HU-DBI scores than their counterparts, respectively. In the Czech Republic, the significant increases in HU-DBI scores occurred after the first academic year when the students received preventive dentistry courses; therefore, one can put forward that early implementation of preventive elements in undergraduate dental curricula may yield better and more sustainable oral health gains for the students. Future research on Czech and Slovak dental curricula need to re-evaluate the oral hygiene and anti-smoking components and their impact on students' views and attitudes., Competing Interests: The authors declare no conflict of interest.

The strategic plan for dentistry and oral health in Estonia of 2030 focuses on oral health promotion and disease prevention through undergraduate dental curricula and fostering public health-oriented research among students. The present study was designed as a descriptive cross-sectional study to evaluate oral health-related knowledge, attitudes, and behaviours (KAB) of dental students in Estonia. The study was carried out in the spring semester of 2020, and it used a modified version of the Hiroshima University Dental Behavioural Inventory (HU-DBI). A total of 129 students responded to the survey, constituting a response rate of 93.5% due to the total population sampling (census) technique used in this study and the small target population size. Out of the 124 students included in the final analysis, 79% were females, 62.1% were clinical students, 11.3% reported smoking tobacco at least once a week, and 86.3% reported problematic internet use. The present study found that mean HU-DBI score of Estonian dental students was 8.09 ± 1.22 which is so far the highest recorded HU-DBI score in Europe. There was no significant difference between female vs. male or preclinical vs. clinical students in terms of HU-DBI score. While clinical students reported less faulty oral hygiene practices, such as hard toothbrush use and aggressive toothbrushing, preclinical students reported a slightly higher mean HU-DBI score. Smoking behaviour was more common among male and clinical students, and it was also associated with alcohol drinking and worry about teeth colour and halitosis.

Dental students are the future leaders of oral health in their respective communities; therefore, their oral health-related attitudes and behaviours are of practical value for primary disease prevention. The present study aimed to evaluate oral health-related knowledge, attitudes, and behaviours of dental students in Arab countries and explore the potential sociodemographic predictors of their oral health outcomes. A multi-centre, cross-sectional study was conducted during the academic year 2019/2020 in three Arab countries: Lebanon, Syria, and Tunisia. The study used a validated Arabic version of the Hiroshima University Dental Behavioural Inventory (HU-DBI) composed of original twenty items that assess the level of oral health-related knowledge, attitudes, and behaviours, and four additional dichotomous items related to tobacco smoking, alcohol drinking, problematic internet use, and regular dental check-up The HU-DBI score ranges between 0 and 12. A total of 1430 students took part in this study, out of which 60.8% were females, 57.8% were enrolled in clinical years, 24.5% were tobacco smokers, 7.2% were alcohol drinkers, and 87% reported internet addiction. The mean HU-DBI score was 6.31 ± 1.84, with Lebanon having the highest score (6.67 ± 1.83), followed by Syria (6.38 ± 1.83) and Tunisia (6.05 ± 1.83). Clinical students (6.78 ± 1.70) had higher HU-DBI scores than their preclinical peers (5.97 ± 1.86). The year-over-year analysis revealed that dental public health and preventive dentistry courses had significantly and positively impacted the undergraduate students' knowledge, attitudes, and behaviours. The gender-based differences were not statistically significant, with a modest trend favouring males, especially oral health behaviours. Tobacco smoking, alcohol drinking, and problematic internet use were associated with lower HU-DBI scores. In the Arab world, the economic rank of the country where the dental students live/study was weakly correlated with the students' mean HU-DBI score.

Background: elementary schoolteachers play a central role in shaping their students' beliefs, attitudes, and behaviours related to health and oral hygiene. This study was designed to evaluate Turkish schoolteachers' levels of oral health knowledge, attitudes, and behaviours., Methods: A cross-sectional survey-based study was conducted among elementary schoolteachers in Istanbul using a validated self-administered questionnaire. The questionnaire was composed of 36 multiple-choice items categorised into six sections, and the participants were recruited using convenience sampling. (3) Results: A total of 385 elementary schoolteachers participated in this study. The majority were female (62.2%), qualified with a licensure degree (81.3%) and working in public schools (86.5%). Female gender and greater work experience were found to be promoters for oral health knowledge and positive attitudes. The correlation between their perceived knowledge and actual knowledge was very weak, thus suggesting that the teachers are inclined to overestimate their knowledge., Conclusions: The Turkish elementary schoolteachers showed satisfactory oral health knowledge and attitudes toward oral health education. The teachers' knowledge about dental trauma management was inadequate, necessitating urgent educational interventions, especially for physical education teachers, who are at the greatest risk of encountering such events during their work. The oral hygiene behaviours were not associated with teachers' oral health knowledge, attitudes, or practice, thus requiring further investigation.

Objective: The aim of the Acromegaly Consensus Group was to revise and update the consensus on diagnosis and treatment of acromegaly comorbidities last published in 2013., Participants: The Consensus Group, convened by 11 Steering Committee members, consisted of 45 experts in the medical and surgical management of acromegaly. The authors received no corporate funding or remuneration., Evidence: This evidence-based consensus was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence following critical discussion of the current literature on the diagnosis and treatment of acromegaly comorbidities., Consensus Process: Acromegaly Consensus Group participants conducted comprehensive literature searches for English-language papers on selected topics, reviewed brief presentations on each topic, and discussed current practice and recommendations in breakout groups. Consensus recommendations were developed based on all presentations and discussions. Members of the Scientific Committee graded the quality of the supporting evidence and the consensus recommendations using the GRADE system., Conclusions: Evidence-based approach consensus recommendations address important clinical issues regarding multidisciplinary management of acromegaly-related cardiovascular, endocrine, metabolic, and oncologic comorbidities, sleep apnea, and bone and joint disorders and their sequelae, as well as their effects on quality of life and mortality., (© Endocrine Society 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019. Published by Elsevier B.V.)

Objective: The optimal time to perform stereotactic radiosurgery after incomplete resection of adrenocorticotropic hormone (ACTH)-producing pituitary adenoma in patients with Cushing's disease (CD) remains unclear. In patients with persistent CD after resection of ACTH-producing pituitary adenoma, the authors evaluated the association of the interval between resection and Gamma Knife radiosurgery (GKRS) with outcomes., Methods: Pooled data from 10 institutions participating in the International Radiosurgery Research Foundation were used in this study., Results: Data from 255 patients with a mean follow-up of 65.59 ± 49.01 months (mean ± SD) were analyzed. Seventy-seven patients (30%) underwent GKRS within 3 months; 46 (18%) from 4 to 6 months; 34 (13%) from 7 to 12 months; and 98 (38%) at > 12 months after the resection. Actuarial endocrine remission rates were higher in patients who underwent GKRS ≤ 3 months than when treatment was > 3 months after the resection (78% and 65%, respectively; p = 0.017). Endocrine remission rates were lower in patients who underwent GKRS at > 12 months versus ≤ 12 months after the resection (57% vs 76%, respectively; p = 0.006). In multivariate Cox regression analyses adjusted for clinical and treatment characteristics, early GKRS was associated with increased probability of endocrine remission (hazard ratio [HR] 1.518, 95% CI 1.039-2.218; p = 0.031), whereas late GKRS (HR 0.641, 95% CI 0.448-0.919; p = 0.015) was associated with reduced probability of endocrine remission. The incidence of some degree of new pituitary deficiency (p = 0.922), new visual deficits (p = 0.740), and other cranial nerve deficits (p = 0.610) was not significantly related to time from resection to GKRS., Conclusions: Early GKRS is associated with an improved endocrine remission rate, whereas later GKRS is associated with a lower rate of endocrine remission after pituitary adenoma resection. Early GKRS should be considered for patients with CD after incomplete pituitary adenoma resection.

Objectives: The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model., Methods: This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign")., Results: Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%)., Conclusion: This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine.

Objective: Pituitary adenomas comprise about 3% of all intracranial tumors in pediatric patients. This study examines the role of stereotactic radiosurgery in the management of pediatric acromegaly or patients with Cushing disease (CD)., Methods: From an international consortium, we retrospectively collected treatment and outcome data on pediatric adrenocorticotrophic hormone and growth hormone-secreting pituitary adenomas treated with Gamma Knife radiosurgery (GKRS). There were a total of 36 patients including 24 with CD and 12 with acromegaly. The data were analyzed to assess outcomes including tumor control, endocrine remission, and adverse effects. Statistical analysis was performed to determine correlation between clinical/treatment parameters and outcomes., Results: At the last follow-up after GKRS, endocrine remission rates for CD and acromegaly were 80% and 42%, respectively. Tumor control was achieved in 87.5% of patients with CD and in 42% of patients with acromegaly. New pituitary hormone deficiency occurred in 7 of the 36 patients at a median time of 18 months after GKRS (range, 12-81 months). The predictive factors for endocrine remission were age <15 years (P = 0.015) and margin dose (P = 0.042). The median endocrine follow-up was 63.7 months (range, 7-246 months)., Conclusions: GKRS affords reasonable rates of endocrine remission and tumor control in most pediatric patients with functioning adenomas. The most common post-GKRS complication was hypopituitarism, although this occurred in only a few patients. Given the larger at-risk period for pediatric patients, further study is required to evaluate for delayed recurrences and hypopituitarism., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aims: To investigate whether static jaw clenching can activate endogenous pain modulation and to compare the magnitude between healthy individuals and patients with temporomandibular disorder (TMD) myalgia., Methods: Thirty-three healthy volunteers (17 women and 16 men) and 20 women with TMD myalgia participated. Exercise-induced hypoalgesia (EIH) was examined by recording pressure pain thresholds (PPTs) in the masseter (MA) and brachioradialis (BR) muscles during tooth clenching until exhaustion. Pain and fatigue were assessed before and after clenching, and pain amplification was examined by applying a painful mechanical pressure at the MA for 2 minutes while assessing pain every 30 seconds. Analyses of data included repeated measures analysis of variance., Results: In the contracting MA, PPTs increased over time in all three groups (P < .001), while PPTs in the relaxed BR increased only in the men (P = .045). Pain intensity and fatigue in the MA increased after contraction in all groups (P < .003) and was higher in the women with TMD than in the healthy women (P < .001). Only the women with TMD showed pain amplification (P < .001)., Conclusion: Tooth clenching until exhaustion could activate EIH locally; ie, the magnitude of EIH in the MA was similar in women with TMD myalgia and pain-free women, indicating no deficient EIH in women with TMD. However, only women with TMD showed pain amplification during application of continuous painful pressure.

Objective: Recurrent or residual adenomas are frequently treated with Gamma Knife radiosurgery (GKRS). The most common complication after GKRS for pituitary adenomas is hypopituitarism. In the current study, the authors detail the timing and types of hypopituitarism in a multicenter, international cohort of pituitary adenoma patients treated with GKRS., Methods: Seventeen institutions pooled clinical data obtained from pituitary adenoma patients who were treated with GKRS from 1988 to 2016. Patients who had undergone prior radiotherapy were excluded. A total of 1023 patients met the study inclusion criteria. The treated lesions included 410 nonfunctioning pituitary adenomas (NFPAs), 262 cases of Cushing's disease (CD), and 251 cases of acromegaly. The median follow-up was 51 months (range 6-246 months). Statistical analysis was performed using a Cox proportional hazards model to evaluate factors associated with the development of new-onset hypopituitarism., Results: At last follow-up, 248 patients had developed new pituitary hormone deficiency (86 with NFPA, 66 with CD, and 96 with acromegaly). Among these patients, 150 (60.5%) had single and 98 (39.5%) had multiple hormone deficiencies. New hormonal changes included 82 cortisol (21.6%), 135 thyrotropin (35.6%), 92 gonadotropin (24.3%), 59 growth hormone (15.6%), and 11 vasopressin (2.9%) deficiencies. The actuarial 1-year, 3-year, 5-year, 7-year, and 10-year rates of hypopituitarism were 7.8%, 16.2%, 22.4%, 27.5%, and 31.3%, respectively. The median time to hypopituitarism onset was 39 months.In univariate analyses, an increased rate of new-onset hypopituitarism was significantly associated with a lower isodose line (p = 0.006, HR = 8.695), whole sellar targeting (p = 0.033, HR = 1.452), and treatment of a functional pituitary adenoma as compared with an NFPA (p = 0.008, HR = 1.510). In multivariate analyses, only a lower isodose line was found to be an independent predictor of new-onset hypopituitarism (p = 0.001, HR = 1.38)., Conclusions: Hypopituitarism remains the most common unintended effect of GKRS for a pituitary adenoma. Treating the target volume at an isodose line of 50% or greater and avoiding whole-sellar radiosurgery, unless necessary, will likely mitigate the risk of post-GKRS hypopituitarism. Follow-up of these patients is required to detect and treat latent endocrinopathies.

Objective: Gamma Knife radiosurgery (GKS) is typically used after failed resection in patients with Cushing's disease (CD) and acromegaly. Little is known about the upfront role of GKS for patients with CD and acromegaly. In this study, the authors examine the outcome of upfront GKS for patients with these functioning adenomas., Methods: An international group of 7 Gamma Knife centers sent pooled data from 46 patients (21 with CD and 25 with acromegaly) undergoing upfront GKS to the coordinating center of the study for analysis. Diagnosis was established on the basis of clinical, endocrine, and radiological studies. All patients were treated on a common radiosurgical platform and longitudinally followed for tumor control, endocrine remission, and hypopituitarism. Patients received a tumor median margin dose of 25 Gy (range 12-40.0 Gy) at a median isodose of 50%., Results: The median endocrine follow-up was 69.5 months (range 9-246 months). Endocrine remission was achieved in 51% of the entire cohort, with 28% remission in acromegaly and 81% remission for those with CD at the 5-year interval. Patients with CD achieved remission earlier as compared to those with acromegaly (p = 0.0005). In patients post-GKS, the pituitary adenoma remained stable (39%) or reduced (61%) in size. Hypopituitarism occurred in 9 patients (19.6%), and 1 (2.2%) developed third cranial nerve (CN III) palsy. Eight patients needed further intervention, including repeat GKS in 6 and transsphenoidal surgery in 2., Conclusions: Upfront GKS resulted in good tumor control as well as a low rate of adverse radiation effects in the whole group. Patients with CD achieved a faster and far better remission rate after upfront GKS in comparison to patients with acromegaly. GKS can be considered as an upfront treatment in carefully selected patients with CD who are unwilling or unable to undergo resection, but it has a more limited role in acromegaly.

Background: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS., Methods: An international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS., Results: A total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm 3 , and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm 3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS and those who underwent discreet adenoma-targeted SRS., Conclusions: Whole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Hypercortisolism in Cushing's syndrome (CS) is associated with impaired health-related quality of life (HRQoL), which may persist despite remission. We used the data entered into the European Registry on Cushing's syndrome (ERCUSYN) to evaluate if patients with CS of pituitary origin (PIT-CS) have worse HRQoL, both before and after treatment than patients with adrenal causes (ADR-CS)., Methods: Data from 595 patients (492 women; 83%) who completed the CushingQoL and/or EQ-5D questionnaires at baseline and/or following treatment were analysed., Results: At baseline, HRQoL did not differ between PIT-CS (n = 293) and ADR-CS (n = 120) on both EuroQoL and CushingQoL. Total CushingQoL score in PIT-CS and ADR-CS was 41 ± 18 and 44 ± 20, respectively (P = .7). At long-time follow-up (>1 year after treatment) total CushingQoL score was however lower in PIT-CS than ADR-CS (56 ± 20 vs 62 ± 23; P = .045). In a regression analysis, after adjustment for baseline age, gender, remission status, duration of active CS, glucocorticoid dependency and follow-up time, no association was observed between aetiology and HRQoL. Remission was associated with better total CushingQoL score (P < .001), and older age at diagnosis with worse total score (P = .01). Depression at diagnosis was associated with worse total CushingQoL score at the last follow-up (P < .001)., Conclusion: PIT-CS patients had poorer HRQoL than ADR-CS at long-term follow-up, despite similar baseline scoring. After adjusting for remission status, no interaetiology differences in HRQoL scoring were found. Age and presence of depression at diagnosis of CS may be potential predictors of worse HRQoL regardless of CS aetiology., (© 2018 John Wiley & Sons Ltd.)