Endocrine Abstracts

Psychiatric manifestations are amongst the most distressing complications in Cushing’s syndrome (CS) and are associated with the severity of the cortisol excess. Depression and anxiety disorders are the most common, whereas mania and psychotic disorders are less frequently reported. Although depression and anxiety disorders improve after successful treatment of the CS, longitudinal studies have shown that they do not fully resolve. Further psychiatric symptoms described in patients in remission include, amongst others, maladaptive personality traits, emotional lability and apathy. Assessment of the mental health status of the patient is of major importance both at diagnosis and during follow-up. The initial approach when managing psychiatric complications in CS is to treat the hypercortisolism. This is further supported by the view that response to antidepressant or antipsychotic medications may not be optimal until the control of cortisol excess. When successful management of the hypercortisolism takes a long interval, psychoeducation and/or psychotherapy may be considered until this is achieved. Selective serotonin re-uptake inhibitors are considered the first choice if antidepressant treatment is required, and low dose clonazepam has been suggested to manage severe anxiety. Treatment of severe psychotic symptoms or psychotic depression is challenging, and atypical antipsychotics may be offered, keeping in mind the possibility of lack of response when CS is active. Psychiatric care in patients with CS in remission is similar to that offered in cases without this condition, and treatment options include psychological, psychosocial and/or pharmacological interventions. Finally, education of patients and their families and direction to support groups are additional important approaches to improve psychiatric comorbidities in CS.