Psychopathology in patients with endogenous Cushing's syndrome: 'atypical' or melancholic features

OBJECTIVE Prolonged elevations of glucocorticoids have been linked to the affective disturbances experienced by patients with Cushing's syndrome. Major depression has been most commonly reported In patients with endogenous Cushing's syndrome. The purpose of this study was to determine whether these patients experience melancholic or ‘atypical’ subtype depression and to determine relations between current psychological functioning and factors such as duration and severity of Cushing's syndrome. DESIGN AND PATIENTS We examined 33 adult patients with documented Cushing's syndrome and 17 hospitalized, matched controls, using standardized structured interviews and tests. RESULTS During the active phase of Cushing's syndrome (prior to and/or on admission), 66.7% of all patients reported histories meeting criteria for a psychiatric diagnosis. Of those with a diagnosis during Cushing's syndrome, 50% reported major depression. Upon presentation to this institution, atypical depression was the most common diagnosis involving 51.5% (n= 17) of ail enrolled patients. Of the 17 with atypical depression, 8 reported a co-morbid psychiatric disorder. The duration of Cushing's syndrome was an Important factor in predicting whether patients sought psychological Intervention or met criteria for psychiatric diagnosis. CONCLUSION Patients with active endogenous Cushing's syndrome exhibit significant psychopathology expressed primarily by atypical depression. Longer duration of Cushing's syndrome may place them at increased risk of such psychopathology.