Altered thalamic volume in patients with mild autonomous cortisol secretion: a structural brain MRI study.

PURPOSE: To compare thalamic volume and cognitive functions of patients with mild autonomous cortisol secretion (MACS) with control subjects and patients with overt Cushing's syndrome (CS). METHODS: In this cross-sectional study, volumes of regions of interest were assessed using 3 T magnetic resonance imaging and a voxel-based morphometry approach in 23 patients with MACS, 21 patients with active CS, 27 patients with CS in remission, and 21 control subjects. Cognitive functions were assessed using validated questionnaires. RESULTS: Patients with MACS had smaller left thalamic (F = 3.8, p = 0.023), left posterior thalamic (F = 4.9, p = 0.01), left medial thalamic (F = 4.7, p = 0.028), and right lateral thalamic (F = 4.1, p = 0.025) volumes than control subjects. Patients with active CS also had smaller left thalamic (F = 3.8, p = 0.044), left posterior thalamic (F = 4.9, p = 0.007), left medial thalamic (F = 4.7, p = 0.006), and right lateral thalamic (F = 4.1, p = 0.042) volumes compared to controls. Patients with CS in remission had smaller left medial (F = 4.7, p = 0.030) and right lateral thalamic (F = 4.1, p = 0.028) volumes than controls. Neuropsychological tests showed no difference between the groups. CONCLUSION: MACS may decrease thalamic volume.

Psychological complications of Cushing's syndrome.

PURPOSE OF REVIEW: The aim of this article is to review and discuss recent evidence of psychological complications in Cushing's syndrome. RECENT FINDINGS: Recent research has described the presence of depression, anxiety, posttraumatic stress disorder, mania, bipolar disorder and psychotic symptoms in patients with Cushing's syndrome. Furthermore, the perspective of patients' partners has also been emphasized. SUMMARY: Recent literature highlights the importance of screening for psychological alterations in Cushing's syndrome, as these alterations can be present in many patients, having a high impact in daily life. Depression is a very common symptom, although in rare cases, patients can also present mania or psychosis. Some studies highlight the importance of screening for organic disease (including Cushing's syndrome) in patients with unexpected or first onset psychiatric symptoms. Finally, the perspective of the patients' partners makes it clear that the partners can also suffer due to the disease of the patient. Intervention programmes involving patient's partners could be helpful to improve both patient and partner wellbeing.

Quality of life in Cushing's syndrome.

Measurement of Health-Related Quality of Life (HRQoL) is emerging as an important clinical endpoint which complements diagnostic workup and contributes to place patients at the centre of the decision-making process through the recognition of their needs, concerns, goals and expectations. Chronic excessive cortisol exposure in Cushing's syndrome (CS) causes severe physical and psychological morbidity which invariably affects HRQoL during the active phase of the disease and even after successful treatment. This sustained deterioration of patient's wellbeing is partly related to the persistence of several features associated with prior cortisol excess, including affective disorders, cognitive dysfunctions and negative illness perception. The aim of this review is to summarize the most recent evidence on HRQoL in CS, including the main determinants of its impairment and the results of some educational programs specifically addressed to improve patient's coping abilities. The preliminary results of an unpublished survey on patient's unmet needs will also be presented.

Mental Health in Patients With Adrenal Incidentalomas: Is There a Relation With Different Degrees of Cortisol Secretion?

CONTEXT: Cushing's syndrome frequently causes mental health impairment. Data in patients with adrenal incidentaloma (AI) are lacking. OBJECTIVE: We aimed to evaluate psychiatric and neurocognitive functions in AI patients, in relation to the presence of subclinical hypercortisolism (SH), and the effect of adrenalectomy on mental health. DESIGN: We enrolled 62 AI patients (64.8 ±â€…8.9 years) referred to our centers. Subclinical hypercortisolism was diagnosed when cortisol after 1mg-dexamethasone suppression test was >50 nmol/L, in the absence of signs of overt hypercortisolism, in 43 patients (SH+). INTERVENTIONS: The structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders-5, and 5 psychiatric scales were performed. The Brief Assessment of Cognition in Schizophrenia (Verbal and Working Memory, Token and Symbol Task, Verbal Fluency, Tower of London) was explored in 26 patients (≤65 years). RESULTS: The prevalence of psychiatric disorders was 27.4% (SH+ 30.2% vs SH- 21.1%, P = 0.45). SH+ showed a higher prevalence of middle insomnia (by the Hamilton Depression Rating Scale) compared with SH- (51% vs 22%, P = 0.039). Considering the Sheehan Disability Scale, SH+ showed a higher disability score (7 vs 3, P = 0.019), higher perceived stress (4.2 ±â€…1.9 vs 2.9 ±â€…1.9, P = 0.015), and lower perceived social support (75 vs 80, P = 0.036) than SH-. High perceived stress was independently associated with SH (odds ratio [OR] = 5.46, confidence interval 95% 1.4-21.8, P = 0.016). Interestingly, SH+ performed better in verbal fluency (49.5 ±â€…38.9 vs 38.9 ±â€…9.0, P = 0.012), symbol coding (54.1 ±â€…6.7 vs 42.3 ±â€…15.5, P = 0.013), and Tower of London (15.1 vs 10.9, P = 0.009) than SH-. In 8 operated SH+, no significant changes were found. CONCLUSIONS: Subclinical hypercortisolism may influence patients' mental health and cognitive performances, requiring an integrated treatment.

Psychiatric and neurocognitive consequences of endogenous hypercortisolism.

Psychiatric and neurocognitive symptoms due to hypercortisolism were already described by Harvey Cushing in his original paper on patients with Cushing's syndrome (CS). Nowadays, it is well known that psychiatric and cognitive complaints are two of the most common, and most distressing, symptoms in patients with CS. Psychiatric symptoms are indeed a major clinical manifestation of CS. The most commonly observed psychiatric conditions are depression and anxiety, whilst mania and psychosis are less common. Several domains of cognitive function are impaired at diagnosis, including episodic and working memory, executive function and attention. Following treatment, one-fourth of the patients still experience depressed mood, and the cognitive impairments are only partially restored. Consequently, quality of life in patients with CS is severely and persistently affected. Neuroimaging studies have also illustrated the deleterious effects of hypercortisolism on the brain by demonstrating reduced grey matter volumes and cortical thickness, altered resting-state functional responses and during cognitive tasks, as well as widespread reduced white matter integrity, especially in structures important for cognitive function and emotional processing, both before and after successful abrogation of hypercortisolism. In this paper, we summarize the current knowledge on the psychiatric and neurocognitive consequences of hypercortisolism in patients with CS, both before, and after successful treatment. In addition, we review the structural and functional brain abnormalities associated with hypercortisolism and discuss the influence of these factors on quality of life.

Computerized Analysis of Brain MRI Parameter Dynamics in Young Patients With Cushing Syndrome-A Case-Control Study.

BACKGROUND: Young patients with Cushing Syndrome (CS) may develop cognitive and behavioral alterations during disease course. METHODS: To investigate the effects of CS on the brain, we analyzed consecutive MRI scans of patients with (n = 29) versus without CS (n = 8). Multiple brain compartments were processed for total and gray/white matter (GM/WM) volumes and intensities, and cortical volume, thickness, and surface area. Dynamics (last/baseline scans ratio per parameter) were analyzed versus cortisol levels and CS status (persistent, resolved, and non-CS). RESULTS: Twenty-four-hour urinary free cortisol (24hUFC) measurements had inverse correlation with the intensity of subcortical GM structures and of the corpus callosum, and with the cerebral WM intensity. 24hUFC dynamics had negative correlation with volume dynamics of multiple cerebral and cerebellar structures. Patients with persistent CS had less of an increase in cortical thickness and WM intensity, and less of a decrease in WM volume compared with patients with resolution of CS. Patients with resolution of their CS had less of an increase in subcortical GM and cerebral WM volumes, but a greater increase in cortical thickness of frontal lobe versus controls. CONCLUSION: Changes in WM/GM consistency, intensity, and homogeneity in patients with CS may correlate with CS clinical consequences better than volume dynamics alone.

Improvement but No Normalization of Quality of Life and Cognitive Functioning After Treatment of Cushing Syndrome.

BACKGROUND: Cushing syndrome is characterized by glucocorticoid excess, which induces physical and mental symptoms, impairments in functional status and perceived health, resulting in impaired quality of life. Biochemical remission is urgently required; however, quality of life and cognitive function may remain impaired. OBJECTIVE: To perform a systematic review and meta-analysis evaluating changes in health-related quality of life and cognitive functioning in patients with Cushing syndrome after treatment. METHODS: Eight electronic databases were searched in March 2017, and PubMed again in May 2018, to identify potentially relevant articles. Eligible studies were (randomized controlled) trials, cohort studies, and cross-sectional studies assessing quality of life or cognitive functioning in patients treated for Cushing syndrome. Differences were expressed as standardized mean difference and reported with 95% confidence intervals. We compared patients before and after treatment (improvement) and patients after treatment and healthy controls (normalization). RESULTS: We included 47 articles with 2643 patients. Most patients had Cushing disease and were in remission after treatment. Quality of life and cognitive functioning improved after treatment in all studied domains. Compared with a healthy control population, quality of life did not normalize. Cognitive functioning normalized in part, but not all, of the studied domains. CONCLUSIONS: Treatment of Cushing syndrome improves quality of life and cognitive functioning. Because normalization was not achieved in quality of life and in some aspects of cognitive functioning, special and continuous attention should be given to these aspects for patients after treatment. Effective interventions for further improvement and possibly normalization are urgently needed.

Hippocampal Volume, Cognitive Functions, Depression, Anxiety, and Quality of Life in Patients With Cushing Syndrome.

CONTEXT: Cushing syndrome (CS) is associated with hippocampal atrophy and psychopathology. OBJECTIVE: The primary objective of this systematic review was to assess hippocampal volume (HV) in patients with CS. The secondary objectives were to assess patients' cognitive functioning, depressive and anxiety symptoms, and quality of life. DATA SOURCES: PubMed, Embase, Cochrane, LILACs, and Scopus databases were searched for relevant studies until 1 May 2019. STUDY SELECTION: Case-control studies comparing patients with CS with healthy control subjects, or studies assessing patients with CS before and after surgery were included. The initial search resulted in 18 studies fulfilling the inclusion criteria. DATA EXTRACTION: Data extraction regarding all outcomes was performed independently by two reviewers. Quality assessment was assessed with the Newcastle-Ottawa Scale for case-control studies. DATA SYNTHESIS: Meta-analysis was performed using a random effect model. The right-side HV in patients with CS was reduced by a standard mean difference of 0.68 (95% CI, -1.12 to -0.24; P = 0.002; I2 = 0%) compared with healthy control subjects, but with no increase in HV after surgery. Patients had more depressive symptoms, impaired cognitive functions, and reduced health-related QoL (HRQoL), which all responded favorably to surgery. The data did not support the presence of anxiety in patients with CS. CONCLUSION: An overall reduction of HV in patients with CS was not suggested by the study findings. However, most cognitive domains were significantly affected and responded favorably to surgery. Depressive symptoms and reduced HRQoL were present in patients with CS and improved after surgery.

Salivary and hair cortisol as biomarkers of emotional and behavioral symptoms in 6-9 year old children.

The aim of the present work is to investigate the association of salivary and cumulative cortisol levels with emotional and behavioral symptoms in a Franconian Cognition and Emotion Studies (FRANCES) general population cohort of 158 6- to 9 year old children. Salivary cortisol values were measured by one-day diurnal cortisol profile, whereas cumulative cortisol was estimated via one-month hair cortisol concentrations (rHCC). Nearly all significant associations of clinical symptoms with child cortisol indices were age dependent: We report emotional symptoms being associated with lower rHCC in younger children (6.06-7.54 years). In older children (7.55-9.41 years) behavioral problems were further associated with higher rHCC and lower salivary cortisol awakening responses. In summary, child clinical symptoms were stronger associated with markers of hair cortisol compared to salivary cortisol. To picture developmental mechanisms, we suggest longitudinal designs for cortisol measures of stress systems in children and adolescents.

How children's anxiety symptoms impact the functioning of the hypothalamus-pituitary-adrenal axis over time: A cross-lagged panel approach using hierarchical linear modeling.

Anxiety symptoms in childhood and adolescence can have a long-term negative impact on mental and physical health. Although studies have shown dysregulation of the hypothalamus-pituitary-adrenal axis is associated with anxiety disorders, it is unclear how and in what direction children's experiences of anxiety symptoms, which include physiological and cognitive-emotional dimensions, impact the functioning of the hypothalamus-pituitary-adrenal axis over time. We hypothesized that higher physiological symptoms would be contemporaneously associated with hypercortisolism, whereas cognitive-emotional symptoms would be more chronic, reflecting traitlike stability, and would predict hypocortisolism over time. One hundred twenty children from the Concordia Longitudinal Risk Research Project were followed in successive data collection waves approximately 3 years apart from childhood through midadolescence. Between ages 10-12 and 13-15, children completed self-report questionnaires of anxiety symptoms and provided salivary cortisol samples at 2-hr intervals over 2 consecutive days. The results from hierarchical linear modeling showed that higher physiological symptoms were concurrently associated with hypercortisolism, involving cortisol levels that remained elevated over the day. In contrast, longitudinal results over the 3 years between data collection waves showed that chronic worry and social concerns predicted hypocortisolism, showing a low and blunted diurnal cortisol profile. These results have implications for broadening our understanding of the links between anxiety, the stress response system, and health across the course of development.

Lack of functional remission in Cushing's syndrome.

INTRODUCTION: Hypercortisolism leads to severe clinical consequences persisting after the onset of remission. These physical sequelae of cortisol exposure are known to profoundly impact the patient's quality of life. As psychological factors may be correlated with this quality of life, our objective was to determine the specific weight of psychological determinants of quality of life in patients in remission from hypercortisolism. PATIENTS AND METHODS: In an observational study, 63 patients with hypercortisolism in remission were asked to complete exhaustive self-administered questionnaires including quality of life (WHOQoL-BREF and Cushing QoL), depression, anxiety, self-esteem, body image, and coping scales. Multivariate analyses were performed. Psychological variables relevant to the model were: anxiety, depression, self-esteem, body image, and positive thinking dimension of the Brief-COPE. Cortisol deficiency was defined as a potential confounder. RESULTS: The median time since remission was 3 years. Patients had significantly lower quality of life and body satisfaction score than the French population and patients with chronic diseases. Depression significantly impaired all WHOQoL and Cushing QoL domains. A low body satisfaction score significantly impaired social relationships quality of life score. In total, 42.9% of patients still needed working arrangements, 19% had disability or cessation of work. CONCLUSION: Patients in biological remission of hypercortisolism can rarely be considered as functionally cured: this is evidenced by altered quality of life, working arrangements, and chronic depression. A multidisciplinary management of these patients is thus mandatory on a long-term basis.

Assessment of health surveys: fitting a multidimensional graded response model.

The multidimensional graded response model, an item response theory (IRT) model, can be used to improve the assessment of surveys, even when sample sizes are restricted. Typically, health-based survey development utilizes classical statistical techniques (e.g. reliability and factor analysis). In a review of four prominent journals within the field of Health Psychology, we found that IRT-based models were used in less than 10% of the studies examining scale development or assessment. However, implementing IRT-based methods can provide more details about individual survey items, which is useful when determining the final item content of surveys. An example using a quality of life survey for Cushing's syndrome (CushingQoL) highlights the main components for implementing the multidimensional graded response model. Patients with Cushing's syndrome (n = 397) completed the CushingQoL. Results from the multidimensional graded response model supported a 2-subscale scoring process for the survey. All items were deemed as worthy contributors to the survey. The graded response model can accommodate unidimensional or multidimensional scales, be used with relatively lower sample sizes, and is implemented in free software (example code provided in online Appendix). Use of this model can help to improve the quality of health-based scales being developed within the Health Sciences.

Hypercortisolemia and Depressive-like Behaviors in a Rhesus Macaque (Macaca mulatta) Involved in Visual Research.

A 10-y-old cranially implanted rhesus macaque (Macaca mulatta) involved in visual research was presented for dull mentation and weight loss. Physical examination revealed alopecia and poor body conditioning, and bloodwork revealed marked hypercortisolemia (23 µg/dL). Differential diagnoses for hypercortisolemia, weight loss, and alopecia included Cushing and pseudo-Cushing syndromes. To further evaluate hypercortisolemia, we compared the urine cortisol:creatinine ratio (UCCR) at baseline and after low-dose dexamethasone suppression (LDDS) testing in the presenting animal and healthy naïve and implanted working monkeys. At baseline, UCCR was 10 times higher in the presenting macaque (118.1 ± 7.1) than in naïve animals (12.5 ± 12.8) and 3 times higher than in healthy implanted working macaques (44.4 ± 6.9); however, levels were suppressed similarly by dexamethasone in both the presenting animal and healthy controls. In addition, healthy implanted working macaques had significantly higher baseline UCCR levels than naïve controls, suggesting chronic stress in working animals. Abdominal ultrasonography and radiographs of the presenting animal revealed marked bilateral adrenal mineralization but no overt adrenal tumor or hyperplasia. Overall, these results excluded endogenous Cushing syndrome and prompted us to evaluate different causes of pseudo-Cushing syndrome, including depression. Using videorecordings to evaluate behavior, we used published criteria for macaque models of depression models, including huddling, to make a presumptive diagnosis of depression. The macaque was treated with fluoxetine (2 mg/kg PO daily), provided increased environmental enrichment, and followed over time by regular UCCR assessment and videorecordings. The animal improved clinically and behaviorally, and UCCR returned to levels observed in working implanted macaques (44.4) after 8 wk of treatment. This case highlights the potential effect of research-related work on stress and pathologic behaviors in macaques and demonstrates the utility of UCCR and LDDS for screening behavioral and hypothalamic-pituitary-adrenal abnormalities in these animals.

Brain structural changes in late-life generalized anxiety disorder.

Late-life Generalized Anxiety Disorder (GAD) is relatively understudied and the underlying structural and functional neuroanatomy has received little attention. In this study, we compare the brain structural characteristics in white and gray matter in 31 non-anxious older adults and 28 late-life GAD participants. Gray matter indices (cortical thickness and volume) were measured using FreeSurfer parcellation and segmentation, and mean diffusivity was obtained through Diffusion Tensor Imaging (DTI). We assessed both macroscopic white matter changes [using white matter hyperintensity (WMH) burden] and microscopic white matter integrity [using fractional anisotropy (FA)]. No differences in macro- or microscopic white matter integrity were found between GAD and non-anxious controls (HC). GAD participants had lower cortical thickness in the orbitofrontal cortex (OFC), inferior frontal gyrus, and pregenual anterior cingulate cortex (ACC). Higher worry severity was associated with gray matter changes in OFC, ACC and the putamen. The results did not survive the multiple comparison correction, but the effect sizes indicate a moderate effect. The study suggests that late-life GAD is associated with gray matter changes in areas involved in emotion regulation, more so than with white matter changes. We conclude that anxiety-related chronic hypercortisolemia may have a dissociative effect on gray and white matter integrity.

Decreased prefrontal functional brain response during memory testing in women with Cushing's syndrome in remission.

Neurocognitive dysfunction is an important feature of Cushing's syndrome (CS). Our hypothesis was that patients with CS in remission have decreased functional brain responses in the prefrontal cortex and hippocampus during memory testing. In this cross-sectional study we included 19 women previously treated for CS and 19 controls matched for age, gender, and education. The median remission time was 7 (IQR 6-10) years. Brain activity was studied with functional magnetic resonance imaging during episodic- and working-memory tasks. The primary regions of interest were the prefrontal cortex and the hippocampus. A voxel-wise comparison of functional brain responses in patients and controls was performed. During episodic-memory encoding, patients displayed lower functional brain responses in the left and right prefrontal gyrus (p<0.001) and in the right inferior occipital gyrus (p<0.001) compared with controls. There was a trend towards lower functional brain responses in the left posterior hippocampus in patients (p=0.05). During episodic-memory retrieval, the patients displayed lower functional brain responses in several brain areas with the most predominant difference in the right prefrontal cortex (p<0.001). During the working memory task, patients had lower response in the prefrontal cortices bilaterally (p<0.005). Patients, but not controls, had lower functional brain response during a more complex working memory task compared with a simpler one. In conclusion, women with CS in long-term remission have reduced functional brain responses during episodic and working memory testing. This observation extends previous findings showing long-term adverse effects of severe hypercortisolaemia on brain function.

Health-related quality of life of patients with hypothalamic-pituitary-adrenal axis dysregulations: a cohort study.

OBJECTIVE: Health-related quality of life (HrQoL) is increasingly considered to be an important outcome of care for hypothalamic-pituitary-adrenal (HPA) axis dysregulation. The objective of this study was to assess the influence of type of HPA axis dysregulation and cortisol status on HrQOL and its evolution with time and treatment. DESIGN: Prospective cohort study. METHODS: Between September 2007 and April 2014, HrQoL questionnaires were administered during routine management to all patients with HPA axis dysregulation hospitalized in a single department, and this was repeated after 6- 12-, 24- and 36-month during standard follow-up. The Medical Outcomes Study 36-item short-form health survey (SF-36) and the General Health Questionnaire 12 (GHQ-12) were used simultaneously, with a common time schedule to measure the impact of HPA axis dysregulation on HrQoL. Multivariate mixed linear regression models were constructed to adjust for potential confounders. RESULTS: 343 patients (206 with Cushing's syndrome of pituitary origin, 91 with Cushing's syndrome of adrenal origin and 46 with Addison's disease) responded to the questionnaires. Overall, HrQoL scores were well below population values. Cushing syndrome of pituitary origin was associated with worse HrQoL, especially in physical dimensions. More than half of the patients, of all diagnoses and cortisol status, had psychological distress requiring attention according to the GHQ-12. Hypercortisolism had the greatest negative influence on HrQoL. CONCLUSIONS: HRQoL appears significantly altered by all forms of HPA axis dysregulation, and most substantially and broadly by Cushing's syndrome, notably during periods of hypercortisolism. These effects on HRQoL deserve further consideration both in clinical practice and research.

Psychiatric Symptoms in Patients with Cushing's Syndrome: Prevalence, Diagnosis and Management.

Cushing's syndrome (CS) results from chronic exposure to cortisol excess, produced by the adrenal cortex. Hypercortisolism predisposes to psychiatric and neurocognitive disorders, mainly to depression and anxiety disorders. Screening tools to identify psychiatric symptoms are available for clinicians in their daily practice, although a specific diagnosis should be performed by specialists. Even if psychiatric symptoms improve after remission of hypercortisolism, complete recovery may not be achieved. Given the burden of these symptoms, psychiatric or psychological monitoring and treatment should be offered through all phases of CS, with a multidisciplinary approach. The aim of this article is to review data on the prevalence, diagnosis and management of psychiatric symptoms seen in patients with CS and to propose therapeutic approaches that may be followed in clinical practice. The prevalence of different psychiatric disorders has been described in both the active phase and after CS remission. Patients may not talk spontaneously about psychiatric symptoms they present, thus clinicians should ask directly about them. We recommend the use of screening tools in clinical practice to detect and treat these symptoms promptly. Even if reference endocrinologists cannot perform a definite psychiatric diagnosis, it will be important to ask patients directly about the presence of symptoms and refer if necessary to a psychiatrist. Additionally, patient information and educational programmes could be useful to manage psychiatric symptoms and to improve quality of life in patients with CS.

Sexualidad de personas con acromegalia y síndrome de Cushing; experiencias y aspectos psicosociales relacionados / Sexuality in people with acromegaly and Cushing's syndrome; experiences and related psychosocial aspects

Antecedentes: aunque la literatura documenta que la acromegalia y el síndrome de Cushing pueden producir dificultades sexuales, los estudios sobre el tema son escasos, especialmente desde la perspectiva de los sujetos. Objetivo: describir el impacto de la acromegalia y el síndrome de Cushing sobre la sexualidad y algunos aspectos psicosociales relacionados, desde la perspectiva de personas con estas enfermedades. Métodos: estudio descriptivo, retrospectivo, cualitativo, con 12 mujeres y 8 varones, atendidos en Instituto Nacional de Endocrinología, Cuba. Se utilizaron entrevistas en profundidad y técnicas psicológicas proyectivas. La información fue transcrita, codificada, interpretada y triangulada. Se consideraron los aspectos éticos. Resultados: las manifestaciones clínicas, corporales y psíquicas de la enfermedad impactaron la sexualidad de la mayoría de los sujetos. Los roles de género y la estética corporal jugaron un rol importante, especialmente en mujeres. La pareja se estructuró como apoyo ante las dificultades sexuales, especialmente en varones. Aparecieron tres perfiles de experiencias sexuales: 1) un grupo refirió que la enfermedad impactó negativamente su sexualidad en forma de dificultades con la erección (varones) y el deseo sexual (mujeres), e incidió en la pareja; 2) otro grupo refirió similares cambios sexuales, pero vividos con menor impacto psicoemocional debido al apoyo de la pareja; 3) un tercer grupo no refirió cambios en la sexualidad ni en la pareja. Se discuten factores relacionados. Conclusiones: las experiencias sexuales de los sujetos son diversas, relacionadas con representaciones sobre pareja, sexualidad, cuerpo y enfermedad. Mujeres y varones muestran diferencias en la influencia del impacto estético y psicoemocional de la enfermedad sobre la sexualidad. Las representaciones (genéricas, corporales, sexuales) más flexibles se relacionan con menor impacto sexual de la enfermedad(AU)

Background: although literature documents that acromegaly and Cushing's syndrome may cause sexual difficulties, the number of studies about the topic is low, mainly from the subjects' perspective. Objective: to describe the impact of acromegaly and Cushing's syndrome on the sexuality and some related psychosocial aspects from the perspective of people living with these diseases. Methods: retrospective, descriptive and qualitative study of 12 women and 8 men who were seen at the National Institute of Endocrinology of Cuba. In depth interviews and projective psychological techniques were used. The collected information was transcripted, coded, construed and triangled. Ethical aspects were taken into consideration. Results: the clinical, body and psychical manifestations of the disease had an impact on the sexuality of most of subjects. The gender role and the body image played significant roles mainly in women. The couple was formed as a support to face sexual difficulties, particularly in men. There were three profiles of sexual experiences: 1) a group stated that the disease had a negative impact on their sexuality regarding difficulties in erection (men) and sexual desire (women) and this influenced on the couple; 2) this group mentioned similar sexual changes but experienced lower psychoemotional impact due to the support of the sexual partner; and 3) the third group did not mention any change in sexuality or in the couple. Related factors were also discussed. Conclusions: sexual experiences of the subjects were varied and related to representations about couple, sexuality, body and disease. Women and men showed differences in the effect of the esthetic and psycho-emotional impact of the disease on sexuality. The most flexible representations (generic, body, sexual) were related to lower sexual impact of disease(AU)

Sexualidad de personas con acromegalia y síndrome de Cushing; experiencias y aspectos psicosociales relacionados / Sexuality in people with acromegaly and Cushing's syndrome; experiences and related psychosocial aspects

Antecedentes: aunque la literatura documenta que la acromegalia y el síndrome de Cushing pueden producir dificultades sexuales, los estudios sobre el tema son escasos, especialmente desde la perspectiva de los sujetos. Objetivo: describir el impacto de la acromegalia y el síndrome de Cushing sobre la sexualidad y algunos aspectos psicosociales relacionados, desde la perspectiva de personas con estas enfermedades. Métodos: estudio descriptivo, retrospectivo, cualitativo, con 12 mujeres y 8 varones, atendidos en Instituto Nacional de Endocrinología, Cuba. Se utilizaron entrevistas en profundidad y técnicas psicológicas proyectivas. La información fue transcrita, codificada, interpretada y triangulada. Se consideraron los aspectos éticos. Resultados: las manifestaciones clínicas, corporales y psíquicas de la enfermedad impactaron la sexualidad de la mayoría de los sujetos. Los roles de género y la estética corporal jugaron un rol importante, especialmente en mujeres. La pareja se estructuró como apoyo ante las dificultades sexuales, especialmente en varones. Aparecieron tres perfiles de experiencias sexuales: 1) un grupo refirió que la enfermedad impactó negativamente su sexualidad en forma de dificultades con la erección (varones) y el deseo sexual (mujeres), e incidió en la pareja; 2) otro grupo refirió similares cambios sexuales, pero vividos con menor impacto psicoemocional debido al apoyo de la pareja; 3) un tercer grupo no refirió cambios en la sexualidad ni en la pareja. Se discuten factores relacionados. Conclusiones: las experiencias sexuales de los sujetos son diversas, relacionadas con representaciones sobre pareja, sexualidad, cuerpo y enfermedad. Mujeres y varones muestran diferencias en la influencia del impacto estético y psicoemocional de la enfermedad sobre la sexualidad. Las representaciones (genéricas, corporales, sexuales) más flexibles se relacionan con menor impacto sexual de la enfermedad(AU)

Background: although literature documents that acromegaly and Cushing's syndrome may cause sexual difficulties, the number of studies about the topic is low, mainly from the subjects' perspective. Objective: to describe the impact of acromegaly and Cushing's syndrome on the sexuality and some related psychosocial aspects from the perspective of people living with these diseases. Methods: retrospective, descriptive and qualitative study of 12 women and 8 men who were seen at the National Institute of Endocrinology of Cuba. In depth interviews and projective psychological techniques were used. The collected information was transcripted, coded, construed and triangled. Ethical aspects were taken into consideration. Results: the clinical, body and psychical manifestations of the disease had an impact on the sexuality of most of subjects. The gender role and the body image played significant roles mainly in women. The couple was formed as a support to face sexual difficulties, particularly in men. There were three profiles of sexual experiences: 1) a group stated that the disease had a negative impact on their sexuality regarding difficulties in erection (men) and sexual desire (women) and this influenced on the couple; 2) this group mentioned similar sexual changes but experienced lower psychoemotional impact due to the support of the sexual partner; and 3) the third group did not mention any change in sexuality or in the couple. Related factors were also discussed. Conclusions: sexual experiences of the subjects were varied and related to representations about couple, sexuality, body and disease. Women and men showed differences in the effect of the esthetic and psycho-emotional impact of the disease on sexuality. The most flexible representations (generic, body, sexual) were related to lower sexual impact of disease(AU)