Children who have undergone successful treatment for Cushing syndrome may be at a higher risk of suicide, depression, anxiety and other mental health conditions after they have been successfully treated, according to a recent study published in the journal Pediatrics. Children who have Cushing syndrome often develop compulsive behaviors and are overachievers in school; however, after treatment they often become anxious or depressed.
Margaret F. Keil, Ph.D., C.R.N.P., a clinical investigator at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health (NIH), and her colleagues reviewed the case histories of 149 children and adolescents who were treated for Cushing syndrome at the NIH from 2003 to 2014.
They reported that nine children had previously undergone successful surgery to treat Cushing syndrome. Seven children experienced an onset of affective symptoms, including thoughts of suicide, outbursts of anger and rage, depression, irritability and anxiety, within seven months of their treatment. In addition, two children experienced symptoms at least four years or later after treatment. The researchers also reported that one child committed suicide 60 months after treatment.
What causes Cushing syndrome?
Cushing syndrome (i.e., hypercortisolism) is a type of endocrine (hormone) disorder that results from having excess cortisol in the body. Cortisol is a glucocorticosteroid hormone that is naturally produced by the adrenal glands and responsible for performing several important functions in the body, including reducing inflammation, maintaining blood pressure and cardiovascular function, regulating metabolism and responding to stress.
People who develop Cushing syndrome most commonly develop it as a result of the prolonged use of glucocorticoid medications such as prednisone and hydrocortisone, which are commonly prescribed to reduce inflammation associated with many common medical conditions, including allergies, asthma, rheumatoid arthritis and eczema. While glucocorticoids are effective for reducing inflammation in the body, their long-term use can be dangerous and even life-threatening as these medications can increase the production of cortisol in the body.
The prolonged use of glucocorticosteroids is the most common cause of Cushing syndrome in adults. This condition may also be caused by a benign or malignant tumor of the adrenal gland (located above the kidney), the lung or some other organ in the body. Cushing syndrome is most common in adults, but approximately 10 percent of new cases diagnosed each year occur in children. Seventy-five percent of children over 7 years old develop Cushing syndrome due to a noncancerous tumor in the pituitary gland, while the most common cause in infants and toddlers is a tumor in the adrenal glands.
Signs and symptoms
The exposure to high levels of cortisol can consequently suppress the function of the immune system (making individuals more vulnerable to serious infection) and lead to problems such as fractures and weakened bones due to osteoporosis, diabetes mellitus from raised blood sugar levels, and increased cholesterol and triglyceride levels — all of which are problems seen in people with Cushing syndrome.
In children, weight gain and growth retardation are hallmark features of Cushing syndrome. Cushing syndrome can also result in symptoms such as:
|Abdominal weight gain with thin arms and legs||Irregular menstrual cycles and balding in women|
|Fatty hump between the shoulders||High blood pressure|
|Round “moon” face||Diabetes and high blood sugar|
|Acne||Weakened bones and fractures due to osteoporosis|
|Blurry vision||Pink or purple stretch marks|
|Fatigue||Thin skin and bruising|
|Cognitive difficulties||Muscle weakness|
|Severe depression||Blood clots|
Serious complications that can result from Cushing syndrome include high blood pressure, diabetes, kidney stones, fractured bones due to osteoporosis, and serious infections due to the suppression of the immune system caused by glucocorticosteroids. Aside from the physical health consequences resulting from having too much cortisol, psychological consequences such as changes in mood, memory problems and psychosis are also seen in adults, adolescents and children who develop Cushing disease.
The results of the new NIH study suggested that health care providers should more adequately screen young people who are in remission from Cushing syndrome for mental illness and monitor them for behavioral changes to avoid negative consequences such as suicide among these children. “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 Constantine Stratakis, M.D., director of the Division of Intramural Research at NICHD, in a press release.
Overall, the study was the first report of affective symptoms and behavioral problems, including the development of suicidal ideation, among children and adolescents after the remission of Cushing syndrome. The researchers suggested that children treated for Cushing syndrome were at a greater risk for depression and other psychological problems and required careful and ongoing monitoring following their treatment to ensure that they do not develop any new behavioral changes or mental health problems.
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About the author
Amanda Habermann, graduated from California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques.