Disturbed cortisol secretion in man: contrasting Cushing's disease and endogenous depression

A disturbed regulation of cortisol secretion is the principal pathology of Cushing's disease and is also the most widely reported neuroendocrine dysfunction in endogenous depression. Because additional clinical signs in both diseases indicated a hypothetical common pathway, we examined 17 patients suffering from Cushing's disease, following a protocol identical to that used in depressed patients (e.g., Hamilton Rating Scale for Depression, self-rating scales, and a clinical interview). Affective disorders, frequently observed in patients with Cushing's disease, were undetectable after surgical treatment (adrenalectomy or microadenomectomy of hypercortisolism). This was an unexpected result, since we found that recovered patients were still characterized by a disturbance of glucocorticoid feedback regulation, probably acting at the hypothalamic level. Our results, as well as numerous reports from others, failed to support the hypothesis that an impaired regulation of cortisol is directly linked to depressive illness.