Cushing’s Disease, Hypertension, and Other Sequels

Singer, Eugenia; Strohm, Sebastian; Göbel, U; Bieringer, Markus; Schmidt, Dierk; Schneider, Wolfgang; Kettritz, Ralph; Luft, Friedrich C.

doi:10.1161/hypertensionaha.108.121640

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…Alongside psychiatric illness, there is also a risk of suicide for patients with Cushing's disease as a result of depression or schizophrenia-like symptoms, hallucinations and illusions [42,43]. In order to prevent suicide attempts, all patients with Cushing's disease should be carefully monitored for the development of depression or schizophrenia-like symptoms and precautions should be considered, where appropriate.…”

Section: Neuropsychiatric Dysfunctionmentioning

confidence: 99%

Cushing’s disease: the burden of illness

et al. 2016

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Cushing's syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing's syndrome is Cushing's disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing's disease is associated with increased mortality, mostly attributable to cardiovascular complications, and a host of comorbidities such as metabolic and skeletal disorders, infections and neuropsychiatric disturbances. As a consequence, Cushing's disease substantially impairs health-related quality of life. It is crucial that the condition is diagnosed as early as possible, and that rapid and effective treatment is initiated in order to limit long-term morbidity and mortality. The initial treatment of choice for Cushing's disease is selective transsphenoidal pituitary surgery; however, the risk of recurrence after initial surgery is high and remains so for many decades after surgery. A particular concern is the growing body of evidence indicating that the negative physical and psychosocial sequelae of chronic hypercortisolism may persist in patients with Cushing's disease even after long-term surgical 'cure'. Current treatment options for post-surgical patients with persistent or recurrent Cushing's disease include second surgery, radiotherapy, bilateral adrenalectomy and medical therapy; however, each approach has its limitations and there is an unmet need for more efficacious treatments. The current review provides an overview of the burden of illness of Cushing's disease, underscoring the need for prompt diagnosis and effective treatment, as well as highlighting the need for better therapies.

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Section: Neuropsychiatric Dysfunctionmentioning

confidence: 99%

Cushing’s disease: the burden of illness

et al. 2016

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Rhythm Disorders in Endocrinology

Priya¹,

Chhabra²,

Kalra³

2021

European Journal of Arrhythmia &Amp; Electrophysiology

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Neuropsychiatric disorders and cognitive dysfunction in patients with Cushing's disease

CHEN,

LI,

CHEN

et al. 2013

Chinese Medical Journal

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Objective To review the main neuropsychiatric disorders and cognitive deficits in patients with Cushing's disease (CD) and the associated pathophysiological mechanisms underlying CD. These mechanistic details may provide recommendations for preventing or treating the cognitive impairments and mood disorders in patients with CD. Data sources Data were obtained from papers on psychiatric and cognitive complications in CD published in English within the last 20 years. To perform the PubMed literature search, the following keywords were input: cushing's disease, cognitive, hippocampal, or glucocorticoids. Study selection Studies were selected if they contained data relevant to the topic addressed in the particular section. Because of the limited length of this article, we have frequently referenced recent reviews that contain a comprehensive amalgamation of literature rather than the actual source papers. Results Patients with active CD not only suffer from many characteristic clinical features, but also show some neuropsychiatric disorders and cognitive impairments. Among the psychiatric manifestations, the common ones are emotional instability, depressive disorder, anxious symptoms, impulsivity, and cognitive impairment. Irreversible effects of previous glucocorticoid (GC) excess on the central nervous system, such as hippocampal and the basal ganglia, is the most reasonable reason. Excess secretion of cortisol brings much structural and functional changes in hippocampal, such as changes in neurogenesis and morphology, signaling pathway, gene expression, and glutamate accumulation. Hippocampal volume loss can be found in most patients with CD, and decreased glucose utilization caused by GCs may lead to brain atrophy, neurogenesis impairment, inhibition of long-term potentiation, and decreased neurotrophic factors; these may also explain the mechanisms of GC-induced brain atrophy and hippocampal changes. Conclusions Brain atrophy and hippocampal changes caused by excess secretion of cortisol are thought to play a significant pathophysiological role in the etiology of changes in cognitive function and psychiatric disturbances. The exact mechanisms by which GCs induce hippocampal volume loss are not very clear till now. So, further investigations into the mechanisms by which GCs affect the brain and the effective coping strategy are essential.

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Cushing’s Disease, Hypertension, and Other Sequels

Cited by 4 publications

References 30 publications

Cushing’s disease: the burden of illness

Cushing’s disease: the burden of illness

Rhythm Disorders in Endocrinology

Neuropsychiatric disorders and cognitive dysfunction in patients with Cushing's disease

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