title: Similar psychopathological profiles in female and male Cushing's disease patients after treatment but differences in the pathogenesis of symptoms.
abstract: BACKGROUND
  Female Cushing's disease (CD) patients with active disease present more frequently with depression compared to their male co-sufferers. This study investigated whether the gender difference prevails after remission and whether gender-specific factors contributing to mental health exist.
  
  
  METHODS
  72 biochemically cured CD patients (11 male, mean age 45.9 ± 13.7 years) who underwent transsphenoidal tumour removal filled out the Symptom Checklist-90-Revised inventory on average 42.1 ± 32.9 months after surgery. Multiple regression analyses included the following independent factors: (i) age, (ii) presence of comorbidities, (iii) presence of hypocortisolism, (iv) presence of hypopituitarism, (v) disease duration until diagnosis, (vi) time elapsed since surgery, and (vii) postoperative radiotherapy to predict postoperative psychopathology.
  
  
  RESULTS
  Regarding the Global Severity Index, 23.0% of the female and 27.3% of the male CD patients presented with abnormal scores. In all nine dimensions, psychopathological abnormalities were present in both female and male patients with the same frequency and intensity (each p > 0.05). Prolonged time to diagnosis was a strong predictive factor for worse psychopathological status only in male patients. Among female patients, only the presence of comorbidities and to some extent pituitary deficiencies were related to psychopathological status.
  
  
  CONCLUSIONS
  During the remission phase of CD, female and male patients present with similar psychopathological profiles. In males, long-term biochemical effects of previous hypercortisolism seem to be salient for psychopathology. In contrast, in females, the presence of comorbidities/stressors they have to cope with is the predictive factor for psychopathology. The results underline gender differences in CD and the need to separate them on various issues.
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Milian
authors.forename: Juergen
authors.initials: J
authors.lastname: Honegger
authors.forename: Christine
authors.initials: C
authors.lastname: Gerlach
authors.forename: Xenia
authors.initials: X
authors.lastname: Hemeling
authors.forename: Tsambika
authors.initials: T
authors.lastname: Psaras
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000150:complications; D008297:Male; D008875:Middle Aged; D047748:Pituitary ACTH Hypersecretion / Q000150:complications / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D012074:Remission Induction; D012720:Severity of Illness Index; D012727:Sex Characteristics; D011795:Surveys and Questionnaires; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult