Course of Depression in Cushing’s Syndrome: Response to Treatment and Comparison with Graves’ Disease

Abstract

Depression is a common, life-threatening complication of Cushing’s syndrome and may occur in several other endocrine disorders. It is not clear, however, whether distinct features pertain to hypercortisohsm. We studied depression in Cushing’s syndrome differentiating pituitary-dependent and pituitary-independent forms, its incidence compared to Graves’ disease, and its appearance in the prodromal phase of both conditions. To 66 consecutive patients with Cushing’s syndrome and 70 with Graves’ disease, after treatment, a semistructured interview for depressive symptoms based on Paykel’s clinical interview for depression was administered. In Cushing’s syndrome, the response of depression to normalization of urinary cortisol levels was evaluated by Kellner’s global rating method. There was a significant difference in the occurrence of depression (p < 0.001) between Cushing’s syndrome (62%) and Graves’ disease (23%). Depression appeared in the prodromal phase in 27% of patients with Cushing’s syndrome and in 14% of those with Graves’ disease, but the difference was not significant. In Cushing’s syndrome, there were no significant differences in depression between patients with pituitary-dependent (n = 41) and pituitary-independent (n = 20) forms, or in their response to treatment. About 70% of patients fully recovered from their depression, whereas there was no substantial change in the others and even worsening in 2. Our findings in Cushing’s syndrome and Graves’ disease are in agreement with previous investigations using specific diagnostic criteria for depression. We found a tendency for this symptom to manifest in the prodromal phase of both illnesses. An endocrine etiology should be, therefore, considered in depressed patients not responding to standard psychiatric treatment.

Psychological aspects of endocrine disease

“…However, disappearance of psychiatric symptoms upon proper endocrine treatment is not always the case. In our experience and in previous investigations using definite diagnostic criteria for depression, about 70% of patients fully recovered from their depression after successful treatment of Cushing's syndrome, whereas there were no substantial changes in the others or even worsening in some (Sonino et al, 1993a). In those who actually deteriorated, the value of appropriate psychiatric intervention was underscored.…”

A Clinical Index for Rating Severity in Cushing’s Syndrome

“…Its clinimetric features were assessed against those of Kellner’s [19]global scales of illness severity and changes after treatment (table 3). These scales are most commonly used for broad ‘global’ ratings [9], are often as sensitive or more sensitive than other criteria [19], and have been previously employed in patients with Cushing’s syndrome [20]. Their interrater agreement was assessed by ICC [16].…”

MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

“…Although the common belief is that depression abates with the 'cure' of CD and the correction of hypercortisolism, few studies have prospectively examined the psychological profiles of patients with CD after correction of the hypercortisolemic state. In general, these studies reported that symptoms of depression decreased but were not eliminated after remission in some, but not all, patients (5,20,74,75,76).…”