Cushing's Syndrome: A Psychiatric Study of 29 Patients

Abstract

Among a consecutive unselected series of 29 patients with Cushing''s syndrome 21 had bilateral adrenal hyperplasia and 8 had tumors. Of the patients, 25 (86%) were significantly depressed; 3 of the tumor patients, but only 1 of the hyperplasia group were free of symptoms so that if there are no psychiatric symptoms there is a 3 in 4 chance that the patient has a tumor. There was a family history of depression or suicide or a history of early bereavement or separation in half the cases. In 6 of the hyperplasia patients a major emotional disturbance had preceded the onset, and in 5 this was a loss. The severity of the depression was not related to the level of circulating cortisol. The depression was rapidly relieved when the tumor or hyperplastic glands were removed. Depression in Cushing''s syndrome might result from a substance other than cortisol produced by the adrenal under excessive pituitary and/or hypothalamic stimulation, which could play a part in the aetiology of depressive illness in general.