BETHESDA, Md., March 29 — Researchers at the National Institutes of Health say doctors should more proactively screen children with Cushing syndrome for depression after treatment because of an increased risk for suicide.
Raised concern for children with the disorder is based on a recent study suggesting changes in mood after they are treated commonly include feelings of depression and anxiety that can be missed by doctors not screening for psychological symptoms.
Cushing syndrome is a disorder caused by high levels of the hormone cortisol. Both children and adults can develop the disorder, which is often linked to tumors on the pituitary, adrenal or other hormone releasing gland, as well as the overuse of drugs to treat asthma, cancer and skin inflammation, among other conditions.
In the case of tumors, removal often stops production of excess cortisol, but the body reacts differently for children and adults. Adults tend to be depressed or anxious before treatment and the symptoms fade over time after treatment. In children, it is the reverse — they develop compulsive behaviors and often become over-achievers in school, but become depressed and anxious after being treated.
“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,” Dr. Constantine Stratakis, director of the Division of Intramural Research at the National Institute of Child Health and Human Development, said in a press release. “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, published in the journal Pediatrics, researchers reviewed medical data for 149 children treated for the disorder between 2003 and 2014.
Months after treatment, the researchers report about 6 percent — nine children — had thoughts of suicide and outbursts of anger, rage, depression, irritability and anxiety. Of them, seven experienced symptoms within seven months of treatment, while two others had symptoms 48 months after they were treated, however all nine showed evidence of remission in the disorder.
The researchers write that they had not seen suicidal ideation reported in Cushing syndrome patients previously, but suggest doctors prepare patients for potential changes in mood and depressive symptoms. This, they say, could improve the rate of patients reporting them, and allow for intervention.
“Health care providers caring for children with Cushing syndrome who have been cured should continue to screen for mental illness, monitor for changes in behavior, and refer as appropriate to mental health professionals,” the researchers write.