THE LONGITUDINAL COURSE OF PSYCHOPATHOLOGY IN CUSHINGS-SYNDROME AFTERCORRECTION OF HYPERCORTISOLISM

Endogenous Gushing's syndrome (CS) is associated with significant psyc hopathology during the course of the disease. The purpose of this stud y was to evaluate the psychological and endocrine status of patients w ith CS after correction of their hypercortisolism. Thirty-three patien ts with active CS were examined before and at 3 months (28 patients), 6 months (25 patients), and 12 months (29 patients) after correction o f hypercortisolism. Before cure, 66.7% of the patients had significant psychopathology, with the predominant diagnosis of atypical depressiv e disorder (AD) in 51.5% and/or major affective disorder in 12%. After cure, overall psychopathology decreased significantly to 53.6% at 3 m onths, 36% at 6 months, and 24.1% at 12 months, when there was a paral lel recovery of the hypothalamic-pituitary-adrenal axis assessed by se rial morning ACTH stimulation tests. There was an inverse correlation between psychological recovery and baseline morning cortisol, but no c orrelation with ACTH-stimulated cortisol values at 60 min. AD continue d to be the prevailing diagnosis after correction of hypercortisolism, whereas the frequency of suicidal ideation and panic increased. The p resence of AD before and after correction of hypercortisolism might be due to glucocorticoid-induced suppression of hypothalamic CRH secreti on. The slight increase in the incidence of panic after correction of hypercortisolism might be due to a decreased glucocorticoid restraint at the central arousal/sympathetic catecholaminergic system. We conclu de that GS is associated with AD symptomatology, which gradually impro ves with time after correction of hypercortisolism. Health care provid ers should be aware of changes in symptomatology, including suicidal i deation and panic attacks, that occur in a subgroup of patients.