NE13 Neuropsychiatric disturbances in patients with Cushing’s syndrome are highly prevalent and may represent the initial manifestation of the disease: The ERCUSYN Krakow Database
TL;DR
Three cases of life-threatening psychiatric disturbances constituting the first clinical CS manifestation are presented and further studies are needed to understand underlying pathophysiological mechanisms, explain inter-etiological differences and evaluate the extent of post-treatment symptom reversibility.
Abstract
Neuropsychiatric symptoms are frequently observed in patients with Cushing’s syndrome (CS), yet their characteristics have not been thoroughly investigated. Common manifestations include depression, anxiety, insomnia, mania, psychosis, and cognitive impairment. This study aimed to characterize neuropsychiatric profiles of patients with CS across different etiologies. A retrospective analysis was performed in 238 patients with CS included in the Krakow cohort of the ERCUSYN database: pituitary (PIT-CS-53%), adrenal (ADR-CS-25%), and ectopic (ECT-CS-22%). Data regarding the occurrence of depression, anxiety disorders, insomnia, mania, psychosis, cognitive impairment, intellectual disability, and suicide attempts were extracted from medical records. Inter-etiological differences were assessed using chi-square test followed by post-hoc pairwise comparisons with Holm–Bonferroni correction (IBM SPSS Statistics 31.0.1.0). Overall, 73% of patients experienced baseline neuropsychiatric symptoms attributable to CS, most commonly insomnia(63%), depression(49%) and anxiety(34%). Other clinically significant presentations included psychosis(7%), mania(3%) and suicidal tendencies(1%). Furthermore, 54% of patients exhibited cognitive decline. In 11% CS diagnosis was preceded with psychiatric treatment. A significantly higher prevalence of anxiety disorders was observed in patients with PIT-CS compared with ADR-CS (34%vs.22%, p=0.005). Psychosis was significantly more frequent in ECT-CS than in PIT-CS (14%vs.6%, p=0.004) and ADR-CS(14%vs.2%, p=0.017). We additionally present three cases of life-threatening psychiatric disturbances constituting the first clinical CS manifestation. Neuropsychiatric disturbances affect most patients with CS and may be initial hypercortisolism manifestation. Increased awareness of such symptoms may accelerate CS diagnosis. Further studies are needed to understand underlying pathophysiological mechanisms, explain inter-etiological differences and evaluate the extent of post-treatment symptom reversibility.