PSYCHOPATHOLOGY IN PATIENTS WITH ENDOGENOUS CUSHINGS-SYNDROME - ATYPICAL OR MELANCHOLIC FEATURES

OBJECTIVE Prolonged elevations of glucocorticoids have been linked to the affective disturbances experienced by patients with Gushing's synd rome. Major depression has been most commonly reported in patients wit h endogenous Gushing's syndrome. The purpose of this study was to dete rmine whether these patients experience melancholic or 'atypical' subt ype depression and to determine relations between current psychologica l functioning and factors such as duration and severity of Gushing's s yndrome. DESIGN AND PATIENTS We examined 33 adult patients with docume nted Gushing's syndrome and 17 hospitalized, matched controls, using s tandardized structured interviews and tests. RESULTS During the active phase of Gushing's syndrome (prior to and/or on admission), 66.7% of all patients reported histories meeting criteria for a psychiatric dia gnosis. Of those with a diagnosis during Gushing's syndrome, 50% repor ted major depression. Upon presentation to this institution, atypical depression was the most common diagnosis involving 51.5% (n = 17) of a ll enrolled patients. Of the 17 with atypical depression, 8 reported a co-morbid psychiatric disorder. The duration of Gushing's syndrome wa s an important factor in predicting whether patients sought psychologi cal intervention or met criteria for psychiatric diagnosis. CONCLUSION Patients with active endogenous Cushing's syndrome exhibit significan t psychopathology expressed primarily by atypical depression. Longer d uration of Gushing's syndrome may place them at increased risk of such psychopathology.