Psychiatric disorders associated with Cushing's syndrome - Epidemiology, pathophysiology and treatment

Gushing's syndrome is caused by a chronic excess of glucocorticoids. A numb er of psychiatric and psychological disturbances may be associated with the condition, regardless of its aetiology. Major depression is the most commo n comorbid disorder. Other psychopathological aspects of Gushing's syndrome in adults include mania, anxiety disorders and cognitive dysfunction. The presence of depression connotes a severe clinical presentation and, in patients with hypothalamic-pituitary forms of Gushing's syndrome, is progno stically useful. Inhibitors of corticosteroid production (e.g. ketoconazole , metyrapone, aminoglutethimide), rather than antidepressant drugs, are gen erally successful in relieving depressive symptoms, as well as other disabl ing symptoms. These drugs can be used to control symptoms prior to surgical treatment of Gushing's syndrome. Long-standing hypercortisolism may cause some degree of irreversible pathol ogical damage and induce highly individualised affective responses based an each patient's psychological assets and iiabiBties. As a result, upon norm alisation of cortisol levels, treatment may still be required, and should e ncompass both psychotherapeutic strategies (particularly cognitive-behaviou ral therapies that have been found to be effective in affective disorders) and psychotropic drug treatment [antidepressants such as tricyclic agents a nd selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors]. In patients with severe anxiety, benzodiazepines (e.g. clonazepam in small do ses) may also be helpful.