Endocrine Abstracts

Introduction: Endogenous Cushing syndrome (CS), is associated with significant morbidity (metabolic, cardiovascular, bone, psychiatric complications among others). Most complications tend to improve if hypercortisolism is controlled but some are only partially reversible or even experience temporary exacerbation.

Patients and Methods: We report 2 cases of adrenal Cushing Syndrome (CS). The first is a 72 years-old female with CS caused by bilateral macronodular adrenal hyperplasia (complicated by diabetes mellitus, arterial hypertension and osteoporosis), treated by bilateral adrenalectomy. The second patient was a 45 years- old female with CS caused by left adrenal adenoma complicated by arterial hypertension and diabetes mellitus, treated by left adrenalectomy.

Results: In the first case the postoperative evolution was complicated by severe gastrointestinal candidiasis (discovered after repetitive episodes of adrenal insufficiency despite adequate replacement with gluco- and mineralcocorticoids) and severe depressive symptoms. These necessitated starting antidepressive medication (tianeptine) with slow control of symptoms over 18 months. In the second case postoperatively the only significant symptom occurring during adequate replacement during the initial months was very severe invalidating depression, slowly improving over several months under treatment with mirtazapine and fluoxetine.

Conclusions: Shortly after successful control of hypercortisolism in certain patients exacerbation or occurrence of serious psychological/psychiatric problems is possible so all patients should be evaluated and followed closely by the endocrinologist which should promptly liaise to psychiatric team whenever needed.