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      Similar Psychopathological Profiles in Female and Male Cushing's Disease Patients after Treatment but Differences in the Pathogenesis of Symptoms

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          Abstract

          Background: Female Cushing's disease (CD) patients with active disease present more frequently with depression compared to their male co-sufferers. This study investigated whether the gender difference prevails after remission and whether gender-specific factors contributing to mental health exist. Methods: 72biochemically cured CD patients (11 male, mean age 45.9 ± 13.7 years) who underwent transsphenoidal tumour removal filled out the Symptom Checklist-90-Revised inventory on average 42.1 ± 32.9 months after surgery. Multiple regression analyses included the following independent factors: (i) age, (ii) presence of comorbidities, (iii) presence of hypocortisolism, (iv) presence of hypopituitarism, (v) disease duration until diagnosis, (vi) time elapsed since surgery, and (vii) postoperative radiotherapy to predict postoperative psychopathology. Results: Regarding the Global Severity Index, 23.0% of the female and 27.3% of the male CD patients presented with abnormal scores. In all nine dimensions, psychopathological abnormalities were present in both female and male patients with the same frequency and intensity (each p > 0.05). Prolonged time to diagnosis was a strong predictive factor for worse psychopathological status only in male patients. Among female patients, only the presence of comorbidities and to some extent pituitary deficiencies were related to psychopathological status. Conclusions: During the remission phase of CD, female and male patients present with similar psychopathological profiles. In males, long-term biochemical effects of previous hypercortisolism seem to be salient for psychopathology. In contrast, in females, the presence of comorbidities/stressors they have to cope with is the predictive factor for psychopathology. The results underline gender differences in CD and the need to separate them on various issues.

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          Most cited references 22

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          Sex differences in anxiety and depression: role of testosterone.

          Compelling evidence exists for pervasive sex differences in pathological conditions, including anxiety and depressive disorders, with females more than twice as likely to be afflicted. Gonadal hormones may be a major factor in this disparity, given that women are more likely to experience mood disturbances during times of hormonal flux, and testosterone may have protective benefits against anxiety and depression. In this review we focus on the effects of testosterone in males and females, revealed in both human and animal studies. We also present possible neurobiological mechanisms underlying testosterone's mostly protective benefits, including the brain regions, neural circuits, and cellular and molecular pathways involved. While the precise underlying mechanisms remain unclear, both activational and organizational effects of testosterone appear to contribute to these effects. Future clinical studies are necessary in order to better understand when and how testosterone therapy may be effective in both sexes.
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            Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects.

            Personality assessment provides a description of a person's fundamental emotional needs and of the higher cognitive processes that modulate thoughts, feelings, and behavior. Prior studies by us examined personality and mood at the same time. Assessing personality may allow prediction of mood changes over time in a longitudinal study, as described in earlier prospective studies by Paula Clayton and others. A group of 631 adults representative of the general population completed the Temperament and Character Inventory (TCI) and Center for Epidemiological Studies depression scale (CES-D) at baseline and one year later. TCI scores at baseline accounted for gender differences in levels of depression. TCI personality scores were strongly stable (range in r=.78 to .85 for each of seven dimensions) whereas mood was only moderately stable (r=.62) over the twelve-month follow-up. Baseline personality scores (particularly high Harm Avoidance and low Self-Directedness) explained 44% of the variance in the change in depression. Baseline levels and changes in Harm Avoidance and Self-Directedness explained 52% of the variance in the change in depression at follow-up. The follow-up sample was representative of the target population except for slightly lower Novelty Seeking scores. Observable personality levels strongly predict mood changes. Personality development may reduce vulnerability to future depression.
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              Cushing's syndrome.

               Jeffrey Orth (1995)
              Cushing's syndrome is usually caused by the secretion of corticotropin or cortisol by a pituitary or adrenal tumor, respectively, or by ectopic secretion of corticotropin. It is possible to determine the specific abnormality in most patients, but it can sometimes be difficult to decide whether the patient has hypercortisolism and whether it is primary or due to major depressive disorder or to the stress of other diseases. Determining the cause of the hypercortisolism involves performing multiple tests in a logical sequence; the results should all be consistent with the same diagnosis. Treatment should aim to cure the hypercortisolism and to eliminate any tumor that threatens the patient's health, while minimizing the chance of an endocrine deficiency or long-term dependence on medications.
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                Author and article information

                Journal
                NEN
                Neuroendocrinology
                10.1159/issn.0028-3835
                Neuroendocrinology
                S. Karger AG
                0028-3835
                1423-0194
                2014
                November 2014
                05 June 2014
                : 100
                : 1
                : 9-16
                Affiliations
                Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
                Author notes
                *Monika Milian, Department of Neurosurgery, University of Tübingen, Hoppe-Seyler-Strasse 3, DE-72076 Tübingen (Germany), E-Mail monika.milian@med.uni-tuebingen.de
                Article
                364878 Neuroendocrinology 2014;100:9-16
                10.1159/000364878
                24902887
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 4, Pages: 8
                Categories
                Original Paper

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