Neuropsychiatric Aspects of Cushing's Syndrome

Trethowan, W. H.; Cobb, Stanley

doi:10.1001/archneurpsyc.1952.02320150016002

Cited by 132 publications

(24 citation statements)

References 10 publications

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“…The detrimental effects of hypercortisolism, such as in CS, on the human brain were first highlighted in autopsy reports, describing a lighter brain and enlarged ventricles in deceased CS patients (9). The first in vivo studies in the human evaluating these brain characteristics were performed in patients with CS using pneumoencephalography.…”

Section: Introductionmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

Andela

Haalen

Ragnarsson

et al. 2015

European Journal of Endocrinology

150

129

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Background: Cushing's syndrome (CS) is characterized by excessive exposure to cortisol, and is associated with both metabolic and behavioral abnormalities. Symptoms improve substantially after biochemical cure, but may persist during long-term remission. The causes for persistent morbidity are probably multi-factorial, including a profound effect of cortisol excess on the brain, a major target area for glucocorticoids. Objective: To review publications evaluating brain characteristics in patients with CS using magnetic resonance imaging (MRI). Methods: Systematic review of literature published in PubMed, Embase, Web of Knowledge, and Cochrane databases. Results: Nineteen studies using MRI in patients with CS were selected, including studies in patients with active disease, patients in long-term remission, and longitudinal studies, covering a total of 339 unique patients. Patients with active disease showed smaller hippocampal volumes, enlarged ventricles, and cerebral atrophy as well as alterations in neurochemical concentrations and functional activity. After abrogation of cortisol excess, the reversibility of structural and neurochemical alterations was incomplete after long-term remission. MRI findings were related to clinical characteristics (i.e., cortisol levels, duration of exposure to hypercortisolism, current age, age at diagnosis, and triglyceride levels) and behavioral outcome (i.e., cognitive and emotional functioning, mood, and quality of life). Conclusion:Patients with active CS demonstrate brain abnormalities, which only partly recover after biochemical cure, because these still occur even after long-term remission. CS might be considered as a human model of nature that provides a keyhole perspective of the neurotoxic effects of exogenous glucocorticoids on the brain.

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Section: Introductionmentioning

confidence: 99%

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

Andela

Haalen

Ragnarsson

et al. 2015

European Journal of Endocrinology

150

129

View full text Add to dashboard Cite

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“…Psychiatric disturbances of psychotic dimensions associated with the exogenous adminitration of steroid hormones have been particularly well recognized (1,2). Hypercortisolism also occurs spontaneously; individual case reports as well as reviews confirm that emotional disturbances are frequent features of its clinical presentation (3). However, prospective studies describing the specific neuropsychiatric abnormalities in patients with Cushing's syndrome, their frequency, and their relationship to the abnormal hormone levels present in this disease are lacking.…”

Section: Introductionmentioning

confidence: 99%

Depressed Mood and Other Psychiatric Manifestations of Cushingʼs Syndrome: Relationship to Hormone Levels

Starkman¹,

Schteingart²,

Schork³

1981

Psychosomatic Medicine

274

102

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Thirty-five consecutive patients with Cushing's syndrome were studied prospectively prior to treatment. A consistent constellation of psychiatric disturbances was found, including impairments in affect (depressed mood and crying), cognitive functions (decreased concentration and memory), and vegetative functions (decreased libido and insomnia). A statistically significant relationship was found between the overall psychiatric disability rating and cortisol and ACTH level. The relationship of depressed mood and hormone levels was examined. Low ACTH levels were significantly associated with milder rather than pronounced depressed mood. The implications of the similarities in psychiatric manifestations between Cushing's syndrome and the primary affective disorders are discussed.

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“…Cushing's syndrome (CS) is associated with a high rate of psychiatric manifestations [1,2], mostly depression and anxiety. In florid CS and Cushing's disease (CD) approximately 54-81% of all patients presenting with a significant psychopathology [3,4,5,6] and a longer duration of CS bear an increased risk for the development of a psychiatric disorder [7].…”

Section: Introductionmentioning

confidence: 99%

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

Milian¹,

Honegger²,

Gerlach³

et al. 2014

Neuroendocrinology

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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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Neuropsychiatric Aspects of Cushing's Syndrome

Cited by 132 publications

References 10 publications

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies

Depressed Mood and Other Psychiatric Manifestations of Cushingʼs Syndrome: Relationship to Hormone Levels

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

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