P268 - ECE_1951 - Depression and anxiety in patients with endogenous Cushing Syndrome: a nationwide matched cohort study using affective drug dispensations
TL;DR
Endogenous CS is associated with a higher risk of treated affective disorders at diagnosis and throughout long-term follow-up, with persistence after remission, underscoring the need for ongoing psychological care.
Abstract
Cushing syndrome (CS) is associated with depression and anxiety. This study compared treated mood and anxiety disorders between patients with CS and controls, assessing differences by etiology and remission status. A retrospective matched cohort study of patients with endogenous CS (2000-2024) from the Clalit Health Services database. Each patient was matched with five controls by age, sex, socioeconomic status, and BMI. Mood and anxiety disorders were identified through affective drug dispensations (ADD). Drug discontinuation was defined as ≥1 month without dispensations. The cohort included 540 patients with CS (mean age 47.8 ± 17.0 years; 64.4% women) and 2517 controls, with a median follow-up of 13.3 years (IQR 8.3-18.5). At baseline, patients with CS had nearly twice the odds of receiving ADD than controls (OR = 1.9, 95% CI,1.3-2.6), with a significant excess in women (12.9% vs 6.9%, OR = 1.9, 95% CI, 1.3-2.8). During follow up, drug discontinuation rates did not differ (HR = 0.7, 95% CI: 0.5-1.0), whereas the risk of new-onset ADD was twofold higher in CS (HR = 2.2, 95% CI, 1.8-2.6), persisting in patients who achieved remission (HR = 2.1, 95% CI, 1.5-2.7) and those who did not (HR = 2.3, 95% CI, 1.6-3.5). Compared to controls, the risk of new-onset ADD was similarly elevated in Cushing disease (HR = 2.4, 95% CI: 1.9-3.1) and adrenal CS (HR = 2.1, 95% CI, 1.9-3.1). Endogenous CS is associated with a higher risk of treated affective disorders at diagnosis and throughout long-term follow-up, with persistence after remission, underscoring the need for ongoing psychological care.