Cushing's syndrome: psychiatric involvement as important aspect of the clinical picture in old age.
Institute di Endocrinology, Catholic University, Rome, Italy.Journal of endocrinological investigation (Impact Factor: 1.45). 02/1999; 22(10 Suppl):83-4.
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ABSTRACT: Stress is commonly associated with a variety of psychiatric conditions, including major depression, and with chronic medical conditions, including diabetes and insulin resistance. Whether stress causes these conditions is uncertain, but plausible mechanisms exist by which such effects might occur. To the extent stress-induced hormonal alterations (e.g., chronically elevated cortisol levels and lowered dehydroepiandrosterone [DHEA] levels) contribute to psychiatric and medical disease states, manipulations that normalize these hormonal aberrations should prove therapeutic. In this review, we discuss mechanisms by which hormonal imbalance (discussed in the frameworks of "allostatic load" and "anabolic balance") might contribute to illness. We then review certain clinical manifestations of such hormonal imbalances and discuss pharmacological and behavioural treatment strategies aimed at normalizing hormonal output and lessening psychiatric and physical pathology.
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ABSTRACT: Untreated hypercortisolism is a fatal state, causing functional disability. Even after successful treatment, clinical recovery is slower than the biochemical one, but data about clinical results, well-being and working capacity after surgery are scarce. This retrospective study aimed at evaluating the long-term outcome of patients after adrenalectomy for ACTH-independent hypercortisolism by the analysis of the clinical results, the survival and the subjective well-being status after surgery. Clinical data in 50 patients suffering from ACTH-independent hypercortisolism and treated between 1980 and 2000 by unilateral adrenalectomy were recorded. At a mean follow-up of 134 months, 3 patients were dead. All the surviving patients were asked to self estimate the physical and psychological recovery after surgery. After surgery, 100% of patients were biochemically cured. A clinical recovery was observed in most cases: obesity in 59.6% and hypertension in 57.5%. Bone mass density (BMD) significantly improved (+20%). The long-term mortality rate did not differ from normal population. Subjectively, a full recovery was confirmed by 95.6% of the surviving patients; it was correlated with the subjective feeling of physical recovery (95.6%) and regained working ability (93.3%). Despite of biochemical and clinical cure, no subjective improvement of the psychological conditions was observed in 26.7% of cases. At long-term follow-up, most objective symptoms of Cushing's syndrome (CS) disappear; subjective health and working ability are often regained, but a psychological impairment could persist in spite of a successful treatment.
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