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Psychosocial Aspects of Cushing’s Disease

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Cushing's Disease

Part of the book series: Endocrine Updates ((ENDO,volume 31))

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Abstract

In recent years, there has been a conceptual shift from a merely ­biomedical approach in disease treatment to a psychosomatic consideration of the entire person and his/her quality of life; with the goal of more effective patient management. The term “psychosomatic” refers to the assumption that mind and body are inseparably linked, and that the person invariably functions and reacts as an integrated mind–body unit. The application of psychosomatic research tools is providing new insight in the setting of endocrine disorders, as it has in other fields of medicine. This chapter reviews the psychosocial aspects in Cushing’s syndrome, characterized by an array of debilitating symptoms and clinical features, in which psychological manifestations play a prominent part, and which may persist despite correction of the underlying biochemical disorder.

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References

  1. Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64:1155–61.

    Article  PubMed  CAS  Google Scholar 

  2. Fava GA, Sonino N. Psychosomatic assessment. Psychother Psychosom. 2009;78:333–41.

    Article  PubMed  Google Scholar 

  3. Sonino N, Tomba E, Fava GA. Psychosocial approach to endocrine disease. In: Porcelli P, Sonino N, editors. Psychosocial factors affecting medical conditions: a new classification for DSM-V, Advances in Psychosomatic Medicine, vol. 28. Basel: Karger; 2007. p. 21–33.

    Chapter  Google Scholar 

  4. Nieman LK, Biller BMK, Findling JW. The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:1526–40.

    Article  PubMed  CAS  Google Scholar 

  5. Pecori Giraldi F. Recent challenges in the diagnosis of Cushing’s syndrome. Horm Res. 2009;71(Supp 1):123–7.

    Article  PubMed  CAS  Google Scholar 

  6. Mullan KR, Atkinson B. Endocrine clinical update: where are we in the therapeutic management of pituitary-dependent hypercortisolism? Clin Endocrinol. 2008;68:327–37.

    CAS  Google Scholar 

  7. Aghi MK. Management of recurrent and refractory Cushing’s disease. Nat Clin Pract Endocrinol Metab. 2008;4:560–8.

    Article  PubMed  Google Scholar 

  8. Boscaro M, Ludlam WH, Atkinson B, et al. Treatment of pituitary-dependent Cushing’s disease with the multireceptor ligand somatostatin analog pasireotide (SOM230): a multicenter, phase II trial. J Clin Endocrinol Metab. 2009;94:115–22.

    Article  PubMed  CAS  Google Scholar 

  9. Wagenmakers MAEM, Netea-Maier RT, van Lindert EJ, et al. Repeated transsfenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing’s disease (CD). Clin Endocrinol. 2009;70:274–80.

    Article  CAS  Google Scholar 

  10. Paykel ES. The interview for recent life events. Psychol Med. 1997;27:301–10.

    Article  PubMed  CAS  Google Scholar 

  11. Cushing H. Psychic disturbances associated with disorders of the ductless glands. Am J Insanity. 1913;69:965–90.

    Google Scholar 

  12. Trethowan WH, Cobb S. Neuropsychiatric aspects of Cushing’s syndrome. AMA Arch Neurol Psychiat. 1952;67:283–309.

    CAS  Google Scholar 

  13. Gifford S, Gunderson JG. Cushing’s disease as a psychosomatic disorder. Medicine. 1970;49:397–409.

    Article  PubMed  CAS  Google Scholar 

  14. Cohen SI. Cushing’s syndrome. A psychiatric study of 29 patients. Br J Psychiatry. 1980;136:120–4.

    Article  PubMed  CAS  Google Scholar 

  15. Sonino N, Fava GA, Boscaro M. A role for life events in the pathogenesis of Cushing’s disease. Clin Endocrinol. 1993;38:261–4.

    Article  CAS  Google Scholar 

  16. Fava GA, Munari F, Pavan L, et al. Life events and depression. J Affect Disord. 1981;3:159–65.

    Article  PubMed  CAS  Google Scholar 

  17. Krystallenia IA, Kaltsas GA, Isidori AM, et al. The prevalence and characteristic features of cyclicity and variability in Cushing’s disease. Eur J Endocrinol. 2009;160:1011–8.

    Article  Google Scholar 

  18. Boscaro M, Rampazzo A, Paoletta A, et al. Patterns of ACTH response to oCRH in Cushing’s disease: correlation with histological/immunocytochemical findings. Neuroendocrinology. 1994;60:237–42.

    Article  PubMed  CAS  Google Scholar 

  19. Dahia PLM, Grossman AB. The molecular pathogenesis of corticotroph tumors. Endocr Rev. 1999;20:136–55.

    Article  PubMed  CAS  Google Scholar 

  20. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5:374–81.

    Article  PubMed  CAS  Google Scholar 

  21. McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583:174–85.

    Article  PubMed  CAS  Google Scholar 

  22. Sonino N, Fava GA. Psychosomatic aspects of Cushing’s disease. Psychother Psychosom. 1998;67:140–6.

    Article  PubMed  CAS  Google Scholar 

  23. Sonino N, Fava GA. Psychiatric disorders associated with Cushing’s syndrome. CNS Drugs. 2001;15:361–73.

    Article  PubMed  CAS  Google Scholar 

  24. Haskett RF. Diagnostic categorization of psychiatric disturbance in Cushing’s syndrome. Am J Psychiatry. 1985;142:911–6.

    PubMed  CAS  Google Scholar 

  25. Hudson JI, Hudson MS, Griffing GT, et al. Phenomenology and family history of affective disorder in Cushing’s disease. Am J Psychiatry. 1987;144:951–3.

    PubMed  CAS  Google Scholar 

  26. Loosen PT, Chambliss B, de Bold CR, et al. Psychiatric phenomenology in Cushing’s disease. Pharmacopsychiatry. 1992;25:192–8.

    Article  PubMed  CAS  Google Scholar 

  27. Kelly WF. Psychiatric aspects of Cushing’s syndrome. Q J Med. 1996;89:543–51.

    CAS  Google Scholar 

  28. Sonino N, Zielezny M, Fava GA, et al. Risk factors and long-term outcome in pituitary-dependent Cushing’s disease. J Clin Endocrinol Metab. 1996;81:2647–52.

    Article  PubMed  CAS  Google Scholar 

  29. Sonino N, Fava GA, Raffi AR, et al. Clinical correlates of major depression in Cushing’s disease. Psychopathology. 1998;31:302–6.

    Article  PubMed  CAS  Google Scholar 

  30. Dorn LD, Burgess ES, Dubbert B, et al. Psychopathology in patients with endogenous Cushing’s syndrome: atypical or melancholic features. Clin Endocrinol. 1995;43:433–42.

    Article  CAS  Google Scholar 

  31. Dorn LD, Burgess ES, Friedman TC, et al. The longitudinal course of psychopathology in Cushing’s syndrome after correction of hypercortisolism. J Clin Endocrinol Metab. 1997;82:912–9.

    Article  PubMed  CAS  Google Scholar 

  32. Ghadirian AM, Marcovitz S, Pearson Murphy BE. A case of seasonal bipolar disorder exacerbated by Cushing’s disease. Compr Psychiatry. 2005;46:155–8.

    Article  PubMed  Google Scholar 

  33. Sonino N, Ruini C, Navarrini C, et al. Psychosocial impairment in patients treated for pituitary disease: a controlled study. Clin Endocrinol. 2007;67:719–26.

    Article  Google Scholar 

  34. Starkman MN, Giordani B, Berent S, et al. Elevated cortisol levels in Cushing’s disease are associated with cognitive decrements. Psychosom Med. 2001;63:985–93.

    PubMed  CAS  Google Scholar 

  35. Sherwood Brown E, Rush AJ, McEwen BS. Hippocampal remodeling and damage by corticosteroids: implications for mood disorders. Neuropsychopharmacology. 1999;21:474–84.

    Article  Google Scholar 

  36. Tooze A, Gittoes NJ, Jones CA, et al. Neurocognitive consequences of surgery and radiotherapy for tumours of the pituitary. Clin Endocrinol. 2009;70:503–11.

    Article  Google Scholar 

  37. Forget H, Lacroix A, Somma M, et al. Cognitive decline in patients with Cushing’s syndrome. J Int Neuropsychol Soc. 2000;6:20–9.

    PubMed  CAS  Google Scholar 

  38. Hook JN, Giordani B, Schteingart DE, et al. Patterns of cognitive change over time and relationship to age following successful treatment of Cushing’s disease. J Int Neuropsychol Soc. 2007;13:21–9.

    Article  PubMed  Google Scholar 

  39. Forget H, Lacroix A, Cohen H. Persistent cognitive impairment following surgical treatment of Cushing’s syndrome. Psychoneuroendocrinology. 2002;27:367–83.

    Article  PubMed  Google Scholar 

  40. Bourdeau I, Bard C, Forget H, et al. Cognitive function and cerebral assessment in patients who have Cushing’s syndrome. Endocrinol Metab Clin N Am. 2005;34:357–69.

    Article  CAS  Google Scholar 

  41. Dorn LD, Cerrone P. Cognitive function in patients with Cushing’s syndrome. A longitudinal perspective. Clin Nurs Res. 2000;9:420–40.

    Article  PubMed  CAS  Google Scholar 

  42. Merke DP, Giedd JN, Keil MF, et al. Children experience cognitive decline despite reversal of brain atrophy one year after resolution of Cushing’s syndrome. J Clin Endocrinol Metab. 2005;90:2531–6.

    Article  PubMed  CAS  Google Scholar 

  43. Mahen FS, Mazzone L, Merke DP, et al. Altered amygdala and hippocampus function in adolescents with hypercortisolemia: A functional magnetic resonance imaging study of Cushing’s syndrome. Dev Psychopathol. 2008;20:1177–89.

    Article  Google Scholar 

  44. Webb SM, Badia X, Barahona MJ, et al. Evaluation of health-related quality of life in patients with Cushing’s syndrome with a new questionnaire. Eur J Endocrinol. 2008;158:623–30.

    Article  PubMed  CAS  Google Scholar 

  45. Armstrong A, Fachnie JD. The phenomenology of Cushing’s syndrome: one patient account. Henry Ford Hosp Med J. 1991;39:8–9.

    PubMed  CAS  Google Scholar 

  46. Gotch PM. Cushing’s syndrome from the patient perspective. Endocrinol Metab Clin N Am. 1994;23:607–17.

    CAS  Google Scholar 

  47. Sonino N, Fava GA, Belluardo P, et al. Course of depression in Cushing’s syndrome: response to treatment and comparison with Graves’ disease. Horm Res. 1993;39:202–6.

    Article  PubMed  CAS  Google Scholar 

  48. Kelly WF, Kelly MJ, Faragher B. A prospective study of psychiatric and psychological aspects of Cushing’s syndrome. Clin Endocrinol. 1996;45:715–20.

    Article  CAS  Google Scholar 

  49. Santos A, Resmini E, Martinez MA, et al. Quality of life in patients with pituitary tumors. Curr Opin Endocrinol Diabetes Obes. 2009;16:299–303.

    Article  PubMed  Google Scholar 

  50. Smith PW, Turza KC, Carter CO, et al. Bilateral adrenalectomy for refractory Cushing’s disease: a safe and definitive therapy. J Am Coll Surg. 2009;208:1059–64.

    Article  PubMed  Google Scholar 

  51. Lindsay JR, Nansel T, Baid S, et al. Long term impaired quality of life in Cushing’s syndrome despite initial improvement after surgical remission. J Clin Endocrinol Metab. 2006;91:447–53.

    Article  PubMed  CAS  Google Scholar 

  52. van Aken MO, Pereira AM, Biermasz NR, et al. Quality of life in patients after long-term biochemical cure of Cushing’s disease. J Clin Endocrinol Metab. 2005;90:3279–86.

    Article  PubMed  Google Scholar 

  53. Heald AH, Ghosh S, Bray S, et al. Long-term negative impact on quality of life in patients with successfully treated Cushing’s disease. Clin Endocrinol. 2004;61:458–65.

    Article  Google Scholar 

  54. Pikkarainen L, Sane T, Reunanen A. The survival and well-being of patients treated for Cushing’s syndrome. J Int Med. 1999;245:463–8.

    Article  CAS  Google Scholar 

  55. Keil MF, Merke DP, Gandhi R, et al. Quality of life in children and adolescents 1-year after cure of Cushing’s syndrome: a prospective study. Clin Endocrinol. 2009;71:326–33.

    Article  Google Scholar 

  56. Sonino N, Bonnini S, Fallo F, et al. Personality characteristics and quality of life in patients treated for Cushing’s syndrome. Clin Endocrinol. 2006;64:314–8.

    Article  Google Scholar 

  57. Barahona MJ, Sucunza N, Resmini E, et al. Persistent body fat mass and inflammatory marker increases after long-term cure of Cushing’s syndrome. J Clin Endocrinol Metabol. 2009;94:3365–71.

    Article  CAS  Google Scholar 

  58. Pivonello R, De Martino MC, De Leo M, et al. Cushing’s syndrome: aftermath of the cure. Arq Bras Endocrinol Metab. 2007;51:1381–91.

    Article  Google Scholar 

  59. Biller BMK, Grossman AB, Stewart PM, et al. Treatment of adrenocorticotropin-dependent Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab. 2008;53:2454–62.

    Article  Google Scholar 

  60. Prevedello DM, Pouratian N, Sherman J, et al. Management of Cushing’s disease: outcome in patients with microadenoma detected on pituitary magnetic imaging. J Neurosurg. 2008;109:751–9.

    Article  PubMed  Google Scholar 

  61. Sonino N, Fava GA. Rehabilitation in endocrine patients: a novel psychosomatic approach. Psychother Psychosom. 2007;76:319–24.

    Article  PubMed  Google Scholar 

  62. Sonino N. The need for rehabilitation teams in endocrinology. Expert Rev Endocrinol Metab. 2008;3:291–3.

    Article  Google Scholar 

  63. Danilovicz K, Bruno OD, Manavela M, et al. Correction of cortisol overreplacement ameliorates morbidity in patients with hypopituitarism: a pilot study. Pituitary. 2008;11:279–85.

    Article  Google Scholar 

  64. Johannsson G, Stibrant Sunnerhagen K, Svensson J. Baseline characteristics and the effects of two years of growth hormone replacement therapy in adults with growth hormone deficiency previously treated for Cushing’s disease. Clin Endocrinol. 2004;60:550–9.

    Article  CAS  Google Scholar 

  65. Hoyby C, Ragnarsson O, Jonsson PJ, et al. Clinical features of GH deficiency and effects of GH replacement in adults with controlled Cushing’s disease. Eur J Endocrinol. 2010;162:677–84.

    Article  Google Scholar 

  66. Boscaro M, Barzon L, Fallo F, et al. Cushing’s syndrome. Lancet. 2001;357:783–91.

    Article  PubMed  CAS  Google Scholar 

  67. Sonino N, Boscaro M, Fallo F, et al. A clinical index for rating severity in Cushing’s syndrome. Psychother Psychosom. 2000;69:216–20.

    Article  PubMed  CAS  Google Scholar 

  68. Newell-Price J, Bertagna X, Grossman AB, et al. Cushing’s syndrome. Lancet. 2006;367:1605–17.

    Article  PubMed  CAS  Google Scholar 

  69. Boscaro M, Arnaldi G. Approach to the patient with possible Cushing’s syndrome. J Clin Endocrinol Metab. 2009;94:3121–31.

    Article  PubMed  CAS  Google Scholar 

  70. Sonino N, Boscaro M. Medical therapy for Cushing’s disease. Endocrinol Metab Clin N Am. 1999;28:211–22.

    Article  CAS  Google Scholar 

  71. Porcelli P, Sonino N. Psychological factor affecting medical conditions: a new classification for DSM-V. Basel: Karger; 2007.

    Google Scholar 

  72. Fava GA, Sonino N. The biopsychosocial model thirty years later. Psychother Psychosom. 2008;77:1–2.

    Article  PubMed  Google Scholar 

  73. Sonino N, Peruzzi P. A psychoneuroendocrinology service. Psychother Psychosom. 2009;78:346–51.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Statistical Sciences, University of Padova, Via Battisti 241, 35121, Padova, Italy

    Nicoletta Sonino

  2. Department of Mental Health, Padova City Hospital, 35100, Padova, Italy

    Nicoletta Sonino

  3. Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA

    Nicoletta Sonino

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  1. Nicoletta Sonino
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Correspondence to Nicoletta Sonino .

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Editors and Affiliations

  1. Massachusetts General Hospital, Dept. Neurosurgery, Harvard Medical School, Parkman St. 15, Boston, 02114, Massachusetts, USA

    Brooke Swearingen

  2. Neuroendocrine Clinical Centre, Massachusetts General Hospital, Fruit St. 55, Boston, 02114, Massachusetts, USA

    Beverly M. K. Biller

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Sonino, N. (2011). Psychosocial Aspects of Cushing’s Disease. In: Swearingen, B., Biller, B. (eds) Cushing's Disease. Endocrine Updates, vol 31. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0011-0_18

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  • DOI: https://doi.org/10.1007/978-1-4614-0011-0_18

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