Psychiatric symptoms as a clinical presentation of Cushing’s syndrome

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Abstract

Cushing’s syndrome can present with a spectrum of symptoms; however, it is less recognised that psychiatric symptoms can form part of the clinical presenting features. In the investigations for an organic cause for a psychiatric illness, Cushing’s syndrome needs to be considered, especially if there are other features such as hirsutism or hypertension. In this article, the two cases reported demonstrate that a prompt diagnosis is not only important for psychiatric management but also crucial for timely institution of the necessary treatment of life-threatening causes of hypercortisolaemia such as metastatic adrenal carcinoma.

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Most cited references 8

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Glucocorticoids. Mood, memory, and mechanisms.

Heather Burke, Owen M. Wolkowitz, E Epel … (2009)

Elevated circulating levels of glucocorticoids are associated with psychiatric symptoms across several different conditions. It remains unknown if this hormonal abnormality is a cause or an effect of the psychiatric conditions. For example, the hypercortisolemia observed in a subset of patients with depression may have a direct impact on the symptoms of depression, but it is also possible that the hypercortisolemia merely reflects the stress associated with depression. Further, rather than causing depression, hypercortisolemia could represent a homeostatic attempt to overcome glucocorticoid resistance. Each of these possibilities will be considered, and correlational and causal evidence will be reviewed. This article will focus on the relationships between glucocorticoids and psychiatric symptoms in Cushing's syndrome, major depression, and steroid psychosis/steroid dementia, as well as the effects of exogenously administered glucocorticoids in normal volunteers. Similarities and differences in the relationship of glucocorticoid hormones to psychiatric symptoms in these conditions will be reviewed. Possible mediators of glucocorticoid effects on the brain and behavior, as well as possible "pro-aging" effects of glucocorticoids in certain cells of the body, will be reviewed. The article concludes with a conceptual model of glucocorticoid actions in the brain that may lead to novel therapeutic opportunities.

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The longitudinal course of psychopathology in Cushing's syndrome after correction of hypercortisolism.

Patricia Dorn, George P. Chrousos, T Friedman … (1997)

Endogenous Cushing's syndrome (CS) is associated with significant psychopathology during the course of the disease. The purpose of this study was to evaluate the psychological and endocrine status of patients with CS after correction of their hypercortisolism. Thirty-three patients with active CS were examined before and at 3 months (28 patients), 6 months (25 patients), and 12 months (29 patients) after correction of hypercortisolism. Before cure, 66.7% of the patients had significant psychopathology, with the predominant diagnosis of atypical depressive disorder (AD) in 51.5% and/or major affective disorder in 12%. After cure, overall psychopathology decreased significantly to 53.6% at 3 months, 36% at 6 months, and 24.1% at 12 months, when there was a parallel recovery of the hypothalamic-pituitary-adrenal axis assessed by serial morning ACTH stimulation tests. There was an inverse correlation between psychological recovery and baseline morning cortisol, but no correlation with ACTH-stimulated cortisol values at 60 min. AD continued to be the prevailing diagnosis after correction of hypercortisolism, whereas the frequency of suicidal ideation and panic increased. The presence of AD before and after correction of hypercortisolism might be due to glucocorticoid-induced suppression of hypothalamic CRH secretion. The slight increase in the incidence of panic after correction of hypercortisolism might be due to a decreased glucocorticoid restraint at the central arousal/sympathetic catecholaminergic system. We conclude that CS is associated with AD symptomatology, which gradually improves with time after correction of hypercortisolism. Health care providers should be aware of changes in symptomatology, including suicidal ideation and panic attacks, that occur in a subgroup of patients.

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A prospective study of psychiatric and psychological aspects of Cushing's syndrome.

W F Kelly, M. Kelly, E Faragher (1996)

Cushing's syndrome is associated with psychiatric and psychological disturbances. The aim of this study was to ascertain the extent of mental illness in patients before and after treatment for Cushing's syndrome.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Gen Psychiatry

Journal ID (iso-abbrev): Ann Gen Psychiatry

Title: Annals of General Psychiatry

Publisher: BioMed Central

ISSN (Electronic): 1744-859X

Publication date Collection: 2013

Publication date (Electronic): 17 July 2013

Volume: 12

Page: 23

Affiliations

[1 ]Department of Endocrinology, St George Hospital, Gray St, Kogarah, New South Wales, Australia

[2 ]Department of Medicine, St George Hospital and UNSW Medicine, University of New South Wales, Kensington, New South Wales, Australia

[3 ]Department of Consultation-Liaison Psychiatry, St George Hospital, Kogarah, New South Wales, Australia

[4 ]Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia

Article

Publisher ID: 1744-859X-12-23

DOI: 10.1186/1744-859X-12-23

PMC ID: 3718650

PubMed ID: 23866099

SO-VID: 4f781e31-af3e-4922-ae24-125ea69d8716

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Psychiatric symptoms as a clinical presentation of Cushing’s syndrome

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Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 8

Glucocorticoids. Mood, memory, and mechanisms.

The longitudinal course of psychopathology in Cushing's syndrome after correction of hypercortisolism.

A prospective study of psychiatric and psychological aspects of Cushing's syndrome.

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