title: Increased prevalence of psychopathology and maladaptive personality traits after long-term cure of Cushing's disease.
abstract: OBJECTIVE
  Psychopathology and maladaptive personality traits are often observed during the active phase of Cushing's disease (CD). We hypothesized that patients with long-term cure of CD show persistent psychopathology and maladaptive personality traits.
  
  
  METHODS
  Four questionnaires on frequently occurring psychopathology in somatic illnesses were used, including the Apathy Scale, Irritability Scale, Hospital Anxiety and Depression Scale, and Mood and Anxiety Symptoms Questionnaire short-form. Personality was assessed using the Dimensional Assessment of Personality Pathology short-form (DAPPs).
  
  
  METHODS
  We included 51 patients cured of CD (16% men, 53 ± 13 yr) and 51 matched controls. In addition, we included 55 patients treated for nonfunctioning pituitary macroadenomas (55% men, 62 ± 10 yr), and 55 matched controls.
  
  
  RESULTS
  Mean duration of remission was 11 yr (range 1-32 yr). Compared with matched controls, patients cured from CD scored significantly worse on virtually all questionnaires. Compared with nonfunctioning pituitary macroadenoma patients, patients treated for CD scored worse on apathy (P < 0.001), irritability (P < 0.001), anxiety (P < 0.001), negative affect and lack of positive affect (P < 0.001 on both scales), somatic arousal (P < 0.001), and 11 of 18 subscales of the Dimensional Assessment of Personality Pathology short-form (P < 0.05).
  
  
  CONCLUSIONS
  Patients with long-term cured CD show an increased prevalence of psychopathology and maladaptive personality traits. These observations suggest irreversible effects of previous glucocorticoid excess on the central nervous system rather than an effect of pituitary tumors and/or their treatment in general. This may also be of relevance for patients treated with high doses of exogenous glucocorticoids.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands. j.tiemensma@lumc.nl
authors.forename: Jitske
authors.initials: J
authors.lastname: Tiemensma
authors.forename: Nienke R
authors.initials: NR
authors.lastname: Biermasz
authors.forename: Huub A M
authors.initials: HA
authors.lastname: Middelkoop
authors.forename: Roos C
authors.initials: RC
authors.lastname: van der Mast
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Romijn
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Pereira
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology* / Q000209:etiology; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000453:epidemiology* / Q000534:rehabilitation* / Q000628:therapy; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D011795:Surveys and Questionnaires; D013997:Time Factors