Abstract
Endogenous Cushing's syndrome (CS), a rare endocrine disorder characterized by cortisol hypersecretion, is associated with psychiatric and neurocognitive disorders. Major depression, mania, anxiety, and neurocognitive impairment are the most important clinical abnormalities. Moreover, patients most often complain of impairment in quality of life, interference with family life, social, and work performance. Surprisingly, after hypercortisolism resolution, despite the improvement of the overall prevalence of psychiatric and neurocognitive disorders, the brain volume loss at least partially persists and it should be noted that some patients may still display depression, anxiety, panic disorders, and neurocognitive impairment. This brief review aimed at describing the prevalence of psychiatric and neurocognitive disorders and their characterization both during the active and remission phases of CS. The last section of this review is dedicated to quality of life, impaired during active CS and only partially resolved after resolution of hypercortisolism.
Highlights
Chronic glucocorticoid (GC) overproduction by the adrenal glands represents the cause of endogenous Cushing’s syndrome (CS), a rare but serious endocrine disorder
GCs have a crucial role in stress response and GC receptors have a pleiotropic distribution in central nervous system (CNS), mainly in the hippocampus; it is not surprising that chronic GC excess can lead to structural and functional changes in CNS, which are mainly based on brain atrophy (De Kloet et al, 1998; Sonino et al, 2010)
As main psychiatric and neurocognitive disorders, the impairment in quality of life (QoL) of patients with CS is only partially resolved after treatment of hypercortisolism and a longer-term follow-up showed that a residual impairment of QoL may persist after long-term disease remission (Lindsay et al, 2006; Wagenmakers et al, 2012)
Summary
MC, Cozzolino A, De Leo M, Iacuaniello D, Pivonello C, Negri M, Pellecchia MT, Iasevoli F and Colao A (2015) Neuropsychiatric disorders in Cushing’s syndrome. Endogenous Cushing’s syndrome (CS), a rare endocrine disorder characterized by cortisol hypersecretion, is associated with psychiatric and neurocognitive disorders. After hypercortisolism resolution, despite the improvement of the overall prevalence of psychiatric and neurocognitive disorders, the brain volume loss at least partially persists and it should be noted that some patients may still display depression, anxiety, panic disorders, and neurocognitive impairment. This brief review aimed at describing the prevalence of psychiatric and neurocognitive disorders and their characterization both during the active and remission phases of CS.
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