title: Increased prevalence of anxiety-associated personality traits in patients with Cushing's disease: a cross-sectional study.
abstract: OBJECTIVE
  Chronic hypercortisolism in Cushing's disease (CD) has been suggested to contribute to an altered personality profile in these patients. We aimed to test this hypothesis and attempted to determine the effects of disease- and treatment-related factors that might moderate an altered personality in CD.
  
  
  METHODS
  We assessed 50 patients with CD (74% biochemically controlled) and compared them to 60 patients with non-functioning pituitary adenomas (NFPA) and 100 age- and gender-matched mentally healthy controls. Personality was measured by two standardized personality questionnaires, TPQ (Cloninger personality questionnaire) and EPQ-RK (Eysenck personality questionnaire-RK).
  
  
  RESULTS
  Compared to mentally healthy controls, CD patients reported significantly less novelty-seeking behaviour, including less exploratory excitability and less extravagance. On harm avoidant subscales, they presented with more anticipatory worries and pessimism, higher fear of uncertainty, shyness with strangers, fatigability and asthenia. Moreover, CD patients appeared to be less extraverted, more neurotic and socially desirable. CD patients differed from NFPA patients in terms of higher neuroticism scores, and NFPA patients did not show altered novelty-seeking behaviour or extraversion. In the subgroup analysis, CD patients with persistent hypercortisolism displayed significantly higher fear of uncertainty, fatigability and asthenia, indicating high harm avoidance in total, than those in biochemical remission.
  
  
  CONCLUSIONS
  Patients with CD showed a distinct pattern of personality traits associated with high anxiety in combination with traits of low externalizing behaviour. Such personality changes should be taken into account in the diagnosis and treatment of CD patients, as they might interfere with the patient-physician communication and/or challenge the patients' social and psychological functioning.
authors.affiliation: Department of Endocrinology, Max Planck Institute of Psychiatry, Munich, Germany. dimopoulou @ mpipsykl.mpg.de
authors.forename: C
authors.initials: C
authors.lastname: Dimopoulou
authors.forename: M
authors.initials: M
authors.lastname: Ising
authors.forename: H
authors.initials: H
authors.lastname: Pfister
authors.forename: J
authors.initials: J
authors.lastname: Schopohl
authors.forename: G K
authors.initials: GK
authors.lastname: Stalla
authors.forename: C
authors.initials: C
authors.lastname: Sievers
mesh_terms: D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D010554:Personality Disorders / Q000453:epidemiology*; D047748:Pituitary ACTH Hypersecretion / Q000453:epidemiology* / Q000523:psychology*; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D011795:Surveys and Questionnaires