PSYCHIATRIC MANIFESTATIONS OF CUSHINGS-SYNDROME - RESPONSE TO LOWERING OF PLASMA-CORTISOL

Abstract

The incidence of psychiatric abnormalities was assessed in 38 patients with Cushing''s syndrome and 2 with alcohol-induced pseudo-Cushing''s syndrome. Patients (26) were examined using a standardized psychiatric interview. This group included all those with severe to moderate psychiatric disorders. Depression was the most common symptom; 5 patients (13%) were markedly or severely depressed, 4 (10%) were moderately depressed and 13 (32%) were mildly depressed. Four patients exhibited other, non-depressive psychiatric symptoms and only 14 (35%) were judged free from psychiatric abnormality. The 1st line of treatment was to reduce the circulating cortisol level either by adrenalectomy or by treatment with oral metyrapone; both patients with alcohol-induced pseudo-Cushing''s syndrome were treated by alcohol withdrawal. Once the plasma cortisol level was successfully controlled, depressive symptoms were relieved in all 5 patients with marked or severe depression and in 3 of the 4 who were moderately depressed. Mild depressive symptoms were relieved in 6 of the 13 affected. Metyrapone may be of considerable value in the management of the acute psychiatric states which may occur in Cushing''s syndrome and these findings are discussed in the light of their possible pathogenesis.