title: Psychiatric Symptoms in Patients with Cushing's Syndrome: Prevalence, Diagnosis and Management.
abstract: Cushing's syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach. The aim of this article is to review data on the prevalence, diagnosis and management of psychiatric symptoms seen in patients with CS and to propose therapeutic approaches that may be followed in clinical practice. The prevalence of different psychiatric disorders has been described in both the active phase and after CS remission. Patients may not talk spontaneously about psychiatric symptoms they present, thus clinicians should ask directly about them. We recommend the use of screening tools in clinical practice to detect and treat these symptoms promptly. Even if reference endocrinologists cannot perform a definite psychiatric diagnosis, it will be important to ask patients directly about the presence of symptoms and refer if necessary to a psychiatrist. Additionally, patient information and educational programmes could be useful to manage psychiatric symptoms and to improve quality of life in patients with CS.
authors.affiliation: Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alicia
authors.identifier: http://orcid.org/0000-0002-2179-6189
authors.initials: A
authors.lastname: Santos
authors.affiliation: Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain. eresmini@santpau.cat.|Universitat Autònoma de Barcelona, Barcelona, Spain. eresmini@santpau.cat.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Resmini
authors.affiliation: Department of Psychiatry, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pascual
authors.affiliation: Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Iris
authors.initials: I
authors.lastname: Crespo
authors.affiliation: Department of Endocrinology/Medicine, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER 747), Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Webb
mesh_terms: D000302:Adrenal Cortex / Q000378:metabolism; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D003480:Cushing Syndrome / Q000150:complications / Q000523:psychology* / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D019468:Disease Management; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011788:Quality of Life
chemical_list: D006854:Hydrocortisone