Differential diagnosis and pathophysiology of Cushing's syndrome and primary affective disorder.
Most patients with major depression have increased 24-hour urinary free cortisol and cortisol nonsuppression after dexamethasone administration, which are cornerstones of a diagnosis of Cushing's syndrome. Similarly, Cushing's syndrome patients often suffer from major psychiatric syndromes, most often depression. These similarities between the two conditions sometimes make it difficult to differentiate them and have led some investigators to suggest they are two points on a spectrum of endocrinologic dysfunction. This article reviews the literature comparing Cushing's syndrome and primary affective disorder and presents two cases that illustrate just how closely these diseases may resemble one another.
Krystal
A
A
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Krishnan
K R
KR
Raitiere
M
M
Poland
R
R
Ritchie
J C
JC
Dunnick
N R
NR
Hanada
K
K
Nemeroff
C B
CB
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D003346:Corticotropin-Releasing Hormone / Q000502:physiology; D003480:Cushing Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D011619:Psychotropic Drugs; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone