These data confirm that ketoconazole is valuable in the management of hypercortisolism, provided that patients are closely watched to exclude those who may develop liver toxicity and to prevent the occurrence of adrenal insufficiency.

Objective: Glucocorticoids were found to inhibit adiponectin gene expression and secretion both in vitro and in animal models. We evaluated first the acute effect of i.v. glucocorticoids on adiponectin in normal subjects and secondly plasma adiponectin levels in a series of patients with Cushing's syndrome compared with controls. Design and methods: Hydrocortisone (25 mg) was administered i.v. to five healthy volunteers, with blood samples taken at 215, 0, 30, 60, 120 and 180 min. Twenty-one patients with Cushing's syndrome were divided in two groups: one with 11 obese and the other with 10 non-obese Cushing's patients. Each group was compared with controls that were matched for sex, age, body mass index, waist circumference, glucose, insulin, lipid levels and blood pressure. Results: In normal subjects, hydrocortisone produced a decrease in adiponectin at 30 and 60 min, compared with placebo (P , 0.05). Adiponectin was lower in non-obese Cushing's patients than in non-obese controls (P , 0.004). In contrast, there was no difference in adiponectin levels in obese Cushing's patients and in obese controls. Adiponectin was inversely correlated (P , 0.05) with homeostasis model assessment index in both obese and non-obese Cushing's patients; in nonobese Cushing's patients only, adiponectin was inversely correlated with urinary cortisol (P , 0.05). Conclusions: Glucocorticoids inhibit adiponectin in man, as shown by both exogenous administration to healthy subjects and endogenous cortisol hyperproduction. Similar levels of adiponectin in obese Cushing's patients and their obese controls indicate that obesity per se may act as a predominant factor in masking the relationship between adiponectin and cortisol.

Background: The purpose of the study was to assess the frequency and characteristics of psychological distress, even after adequate treatment, in the heterogeneous population of an endocrine outpatient clinic. Methods: 146 endocrine patients (31 males/115 females; age 39.4 ± 12.5 years), who were cured or in remission, were studied in a university endocrine outpatient clinic. Semistructured clinical interviews to assess psychiatric (Structured Clinical Interview for DSM-IV) and psychological (Diagnostic Criteria for Psychosomatic Research, DCPR) diagnoses were employed and were supplemented by self-rated instruments (the Psychosocial Index and the Medical Outcome Study short form General Health Survey) which could provide the patients’ perception of their own quality of life. Results: There were 118 patients (81%) who presented with at least 1 psychiatric (DSM-IV) or psychological (DCPR) diagnosis. The most frequent diagnostic findings were generalized anxiety disorder (29%), major depression (26%), irritable mood (46%), demoralization (34%) and persistent somatization (21%). By self-rated instruments, patients with at least 1 DSM-IV or DCPR diagnosis reported significantly more stressful life circumstances, psychological distress and an impaired quality of life compared to those who had none. Conclusions: A high prevalence of psychological distress may be encountered in the long-term follow-up of endocrine patients. A biopsychosocial consideration of the person and his/her quality of life appears to be mandatory for improving therapeutic effectiveness in endocrine disorders.

At follow-up after appropriate treatment, we documented a high prevalence of psychopathology in patients with pituitary disease, which was however, similar to that found in nonpituitary endocrine patients. This is consistent with an increasing body of literature that reports difficulties in obtaining full recovery in patients treated for endocrine disorders.

Cardiac autonomic functions and sympathovagal balance are altered in patients affected by acromegaly and could be ameliorated by SSAs therapy. HRV analysis allows an estimation of the autonomic sympathovagal balance and may be a useful clinical tool for the cardiac risk stratification in acromegalic patients.