Increased prevalence of psychopathology and maladaptive personality traits in patients after long-term cure of Cushing's disease
Jitske Tiemensma, Nienke Biermasz, Huub Middelkoop, Roos van der Mast, Johannes Romijn & Alberto Pereira
Objective: Psychopathology and maladaptive personality traits are often observed during the active phase of Cushings disease (CD). We hypothesized that patients with long-term cure of CD show persistent psychopathology and maladaptive personality traits.
Aim: To evaluate psychopathology and personality traits in patients with long-term cure of CD.
Patients and methods: We included 67 patients cured of CD (15% males, mean age 53 years) and 67 matched controls. In addition, we included 55 patients treated for nonfunctioning pituitary macroadenomas (NFMA), and 55 matched controls (55% males, mean age 62 years). All patients and controls completed questionnaires on frequently occurring psychopathology in somatic illness including the apathy scale, irritability scale, hospital anxiety and depression scale (HADS), and mood and anxiety symptoms questionnaire short-form (MAQ8-30). Personality was assessed using the dimensional assessment of personality pathology short-form (DAPP). The protocol was approved by the Medical Ethics Committee.
Results: Mean remission duration of CD was 13 years (range 50 years). Compared to matched controls, patients treated for CD scored significantly worse on virtually all questionnaires. Compared to NFMA patients, patients treated for CD scored worse on apathy (P=0.010), irritability (P=0.004), negative affect and lack of positive affect (P=0.006 and P=0.003, respectively), somatic arousal (P=0.023), and 11 out of 18 subscales of the DAPP (P<0.05).
Conclusion: Patients with long-term cured CD show an increased prevalence of psychopathology and maladaptive personality traits, compared to matched controls as well as patients treated for NFMA. This suggests an irreversible effect of previous glucocorticoid excess on the central nervous system rather than an effect of a pituitary tumor and/or its treatment in general. These observations may also be of relevance for patients treated with high doses of exogenous glucocorticoids.