ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P735 | DOI: 10.1530/endoabs.63.P735

The changing face of cushing disease in the 21st century: mood disorders and body image perception

Claudio Urbani1, Elisa Lai2, Antonio Ciapparelli3, Gaspare Alfi2, Michele Mantuano1, Danilo Menicucci4, Ilaria Scattina1, Giulia Marconcini1, Daniele Cappellani1, Claudio Marcocci1, Luca Manetti1, Angelo Gemignani2 & Fausto Bogazzi1


1Endocrinology Section, Department of Clinical and Experimental Medicine, University of Pisa,, Pisa, Italy; 2Psychology Unit, Department of Surgical and Critical Area Pathology, University of Pisa, Pisa, Italy, Pisa, Italy; 3Psychiatry Section, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy; 4Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.


Introduction: Cushing’s Disease (CD) has been associated with the occurrence of psychopathologies, the most frequent of which are depression and anxiety. However, the extent of psychopathological disturbances of CD in the 21st century is elusive.

Objectives: To explore psychopathologies and body image uneasiness (BIU) in untreated CD patients.

Patients & methods: It was a prospective observational study enrolling 23 consecutive naïve CD and 23 matched subjects with a non-functioning pituitary adenoma (NF), used as controls. All subjects underwent a psychiatric evaluation and psychological questionnaires to explore the occurrence of psychopathologies (SCL-90R), mood (POMS, BDI-II), anxiety (SAS, STAI-2Y), body image uneasiness (BUT), and QoL (SF-36). Four CD have been preliminarily excluded due to a treated psychiatric disorder (n=2) or to a lack of reliability of surveys replies. Psychological inventories were evaluated as continuous as well as categorical variables according to the questionnaires interpretation rules. We used group comparison to differentiate between CD and NF and association analysis to examine the relationship between clinical and biochemical features of CD and psychological results.

Results: CD patients had higher scores than NF in almost all psychological scales. Similarly, when subjects were categorized according to the distress degree emerged from the questionnaires, we observed a generalized tendency toward the higher score classes in the CD cohort for the majority of the domains. However, when patients were grouped on the basis of the achievement of the pathological thresholds indicated by questionnaires, CD differed from controls only for the somatization and obsessive-compulsive subscales of SCL-90R and the anger subscale of POMS. CD and NF did not differ for the presence of pathological depressive and anxiety symptoms. Likewise, the psychiatric evaluation did not show differences between CD and NF for the prevalence of depression (9 vs. 0%) and anxiety (4 vs. 0%). Naïve CD showed a profound disturbance in BIU that was mainly related to body areas that change following CD (i.e., face, abdomen, and skin). Sex, age, BMI, the educational level, and the severity of CD did not have a role in the occurrence of psychopathologies and BIU of CD.

Conclusions: Untreated CD patients had overall distress in all assessed psychopathological domains compared to NF. However, the analysis of symptoms severity suggests that the psychopathological impairment of the CD remains subclinical in most cases. A disturbance of the body image characterizes CD patients and can contribute to the occurrence of psychopathologies and the reduced QoL of CD.