Children with Cushing syndrome may be at greater for depression, anxiety and suicide long after they have been successfully treated, according to a new study at the National Institutes of Health (NIH).
Cushing syndrome is a rare endocrine disorder characterized by high levels of the hormone cortisol. The excess cortisol is often caused by a tumor on the adrenal or pituitary glands, and treatment usually involves removal of the tumor. The disorder may also be caused by taking large amounts of steroid medications, such as prednisone.
Patients with Cushing syndrome may experience muscle weakness, mood swings, severe fatigue, diabetes, bone fractures, high blood pressure, kidney stones, and serious infections. They also tend to put on weight in their midsection and develop fatty deposits in their upper back and neck.
Children with Cushing syndrome often exhibit compulsive behaviors and may even be over-achievers in school. After treatment, however, they often develop symptoms of depression and anxiety. This is in direct contrast to adults with Cushing syndrome, who tend to experience depression and anxiety before treatment and gradually overcome these symptoms after treatment.
“Our results indicate that physicians who care for young people with Cushing syndrome should screen their patients for depression-related mental illness after the underlying disease has been successfully treated,” said senior author, Constantine Stratakis, director of the Division of Intramural Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.
“Patients may not tell their doctors that they’re feeling depressed, so it’s a good idea for physicians to screen their patients proactively for depression and related conditions.”
For the study, the researchers analyzed the case histories of all children and youth who had been treated for Cushing syndrome at NIH from 2003 to 2014, a total of 149 patients. The researchers found that, months after treatment, nine children (roughly six percent) had thoughts of suicide and experienced outbursts of anger and rage, depression, irritability, and anxiety.
Of these, seven children experienced symptoms within seven months of their treatment, while two children developed symptoms much later — at least 48 months after treatment.
The researchers suggest that health care providers prepare children with Cushing syndrome before they undergo treatment, letting them know that their mood may change after surgery and may not improve for months or years. Young patients should also be screened periodically for suicide risk in the years following treatment.
The findings are published in the journal Pediatrics.