Endocrine Abstracts

Context: Endogenous Cushing’s syndrome (CS) may have different effects in children than what has been described in adults. Prior studies of children and adolescents with CS have identified cognitive decline despite reversal of brain atrophy after remission of CS, as well as residual impairment in quality of life measures. Although the observations of parents of children and adolescents with CS support personality changes, significant psychopathology has not been described in the literature.

Setting: Subjects were enrolled in a clinical protocol at the National Institutes of Health Clinical Center in Bethesda, MD, USA.

Clinical presentation: We report six children (4M, 12.4±2.5 years), who underwent successful transsphenoidal surgery (TSS) for treatment of Cushing’s disease (CD), and subsequently developed significant affective symptoms (range for onset of symptoms 4–60 months). Affective symptoms included: decline in school performance, anger/rage outbursts, suicidal ideation, anxiety, and depression. One child (18 years old female), who committed suicide 60 months post-TSS, had recently discontinued antidepressant medication. She had a history of anxiety during active CS and was treated with an anxiolytic. The 4 patients with onset of symptoms within 7 months of TSS were on glucocorticoid replacement, and 1 year follow-up evaluation showed recovery of HPA axis and biochemical evidence of remission. The two patients who presented with onset of symptoms 48 months or later, underwent endocrine evaluation that showed biochemical evidence of remission and normal anterior pituitary hormone levels.

Conclusion: A longitudinal study of adults reported an incidence of psychopathology of 66.7% in active CS that declined to 24.1% at 12-month after remission (Dorn 1997). This is the first report of affective symptomology/behavioral dysregulation, including suicidal ideation, in a subgroup of children and adolescents after remission of CS. Health care providers should screen for changes in symptomology, including suicidal ideation, anger outbursts, anxiety, and depression and refer to appropriate mental health professionals.