Psychotropic Drugs in Patients with Cushing’s Disease Before Diagnosis and at Long-Term Follow-Up: A Nationwide Study

Author:

Bengtsson Daniel12ORCID,Ragnarsson Oskar34ORCID,Berinder Katarina56ORCID,Dahlqvist Per7ORCID,Edén Engström Britt89ORCID,Ekman Bertil10ORCID,Höybye Charlotte56ORCID,Burman Pia11ORCID,Wahlberg Jeanette1012ORCID

Affiliation:

1. Department of Internal Medicine, Kalmar, Region of Kalmar County, Kalmar, Sweden

2. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

3. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

4. Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden

5. Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden

6. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

7. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

8. Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University, Uppsala, Sweden

9. Department of Endocrinology and Diabetes, Uppsala University Hospital, Uppsala, Sweden

10. Department of Endocrinology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

11. Department of Endocrinology, Skåne University Hospital, University of Lund, Malmö, Sweden

12. Faculty of Medical Sciences, Örebro University, Örebro, Sweden

Abstract

Abstract Context Psychiatric symptoms are common in Cushing’s disease (CD) and seem only partly reversible following treatment. Objective To investigate drug dispenses associated to psychiatric morbidity in CD patients before treatment and during long-term follow-up. Design Nationwide longitudinal register-based study. Setting University Hospitals in Sweden. Subjects CD patients diagnosed between 1990 and 2018 (N = 372) were identified in the Swedish Pituitary Register. Longitudinal data was collected from 5 years before, at diagnosis, and during follow-up. Four matched controls per patient were included. Cross-sectional subgroup analysis of 76 patients in sustained remission was also performed. Main outcome measures Data from the Swedish Prescribed Drug Register and the Patient Register. Results In the 5-year period before and at diagnosis, use of antidepressants (odds ratio [OR] 2.2 [95% confidence interval (CI) 1.3-3.7]) and 2.3 [1.6-3.5]), anxiolytics [2.9 (1.6-5.3) and 3.9 (2.3-6.6)], and sleeping pills [2.1 (1.2-3.7) and 3.8 (2.4-5.9)] was more common in CD than controls. ORs remained elevated at 5-year follow-up for antidepressants [2.4 (1.5-3.9)] and sleeping pills [3.1 (1.9-5.3)]. Proportions of CD patients using antidepressants (26%) and sleeping pills (22%) were unchanged at diagnosis and 5-year follow-up, whereas drugs for hypertension and diabetes decreased. Patients in sustained remission for median 9.3 years (interquartile range 8.1-10.4) had higher use of antidepressants [OR 2.0 (1.1-3.8)] and sleeping pills [2.4 (1.3-4.7)], but not of drugs for hypertension. Conclusions Increased use of psychotropic drugs in CD was observed before diagnosis and remained elevated regardless of remission status, suggesting persisting negative effects on mental health. The study highlights the importance of early diagnosis of CD, and the need for long-term monitoring of mental health.

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference37 articles.

1. Cushing’s syndrome;Lacroix;Lancet.,2015

2. Comorbidities in Cushing’s disease;Sharma;Pituitary.,2015

3. Complications of Cushing’s syndrome: state of the art;Pivonello;Lancet Diabetes Endocrinol.,2016

4. Overall and disease-specific mortality in patients with Cushing disease: A Swedish Nationwide Study;Ragnarsson;J Clin Endocrinol Metab.,2019

5. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism);Cushing;Bull Johns Hopkins Hosp.,1932

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