Changes in Body Image and Pain in Patients with Cushing Syndrome: A Predictor for Depression and Vice Versa

Cushing syndrome (CS) is a rare disease with severe physical and psychological effects, especially depression, which often persists despite biochemical remission.

The aim of this study was to identify possible prognostic markers for depression in patients with CS.

Biochemical and clinical data from the German Cushing registry were retrospectively analyzed, along with the Beck Depression Inventory II and Patient Health Questionnaire-9 depression scores. Pain and body image were collected using the Fragebogen zum eigenen Körpers (Questionnaire on one's own body) (FBeK), Fragebogen Körperbild (Questionnaire on body image) (FKB-20), and a numerical analogue scale for pain. The study included 90 patients with CS and 200 controls with clinically suspected but biochemically excluded CS. For detailed analysis, 15 CS patients with and 10 CS patients without depression were examined.

Manifest depression was diagnosed in 44% of CS patients. There were no significant differences in anthropometric or biochemical parameters between patients with and without depression. Patients with persistent depression exhibited significantly more negative body image results (FBeK: scales 1 and 2, P < .001; FKB-20: vital body dynamics, P < .001; and negative body perception, P = .02). They also reported significantly higher pain levels (P < .001). A significant correlation between pain and body image disturbances was found in most questionnaires. In comparison to depressive and obese groups from the literature, CS patients present with a complex body image disturbance.

Pain and body image are relevant factors influencing depressive mood. CS treatment should address the physical changes and the body's lack of energy, strength, and ability to cope with everyday life.