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Cushing’s disease and melancholia.
1St. Vincent’s Hospital, Richmond Rd., Fairview, Dublin 3, Ireland. jthakore@indigo.ie
Stress (Amsterdam, Netherlands)
|March 21, 2012
Summary
Cushing's disease and melancholic depression share similar hormonal abnormalities and physical complications, often due to excessive glucocorticoids. Differentiating these conditions requires specific endocrine tests.
Area of Science:
- Endocrinology
- Psychiatry
- Internal Medicine
Background:
- Cushing's disease and melancholic depression exhibit striking endocrinological similarities.
- Both conditions can present with hypercortisolism, making differentiation challenging and leading to a
Purpose of the Study:
- To explore the endocrinological and physical similarities between Cushing's disease and melancholic depression.
- To highlight the diagnostic challenges and potential differentiating factors using dynamic endocrine tests.
Main Methods:
- Comparative analysis of laboratory abnormalities, including cortisol and adrenocorticotrophin (ACTH) levels.
- Review of dynamic endocrine tests such as the dexamethasone suppression test, dexamethasone-CRH test, and synacthen response.
- Examination of shared physical complications like osteoporosis and cardiovascular risks.
Main Results:
- Both disorders show elevated urinary, plasma, and salivary cortisol, non-suppression in dexamethasone tests, and ACTH hypersecretion.
- Cerebrospinal fluid corticotrophin-releasing hormone (CRH) is lower in Cushing's disease than depression.
- Depression shows a reduced ACTH response to CRH, unlike Cushing's disease.
Conclusions:
- Excessive plasma glucocorticoids are proposed as the common underlying factor for shared physical complications.
- Early detection and treatment of depression are crucial due to its associated morbidity and mortality.
- Screening for physical complications in patients with depression is necessary.
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