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Cushing syndrome and mood — MRCPsych Paper A MCQ

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ModerateNeuroimaging, neuroendocrinology and psychoneuroimmunologyCushing syndrome and moodMRCPsych Paper A

A 42-year-old woman presents with a depressive episode. She has recently developed hypertension, difficulty rising from a chair, spontaneous bruising, facial rounding and predominantly truncal weight gain with relatively thin limbs. Which endocrine abnormality is most likely to account for the full presentation?

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Correct answer: C — Sustained excess cortisol secretion in Cushing syndrome

The correct answer is C: sustained excess cortisol secretion in Cushing syndrome. Depression is a recognised neuropsychiatric manifestation of hypercortisolism. The accompanying proximal myopathy, easy bruising, hypertension, facial rounding and truncal adiposity with relatively thin limbs form a characteristic Cushing phenotype. Hypothyroidism can cause low mood, weight gain and weakness, but does not typically produce this combination of skin fragility, fat redistribution and proximal myopathy. A delayed sleep–wake phase disorder does not explain the systemic physical signs. Pituitary infarction usually causes multiple pituitary hormone deficiencies rather than this hypercortisolaemic phenotype. Insulin deficiency produces hyperglycaemic symptoms and generally weight loss, not central adiposity and easy bruising.

Reference: Valassi E, et al. Clinical presentation and etiology of Cushing's syndrome: Data from ERCUSYN. 2022. https://pubmed.ncbi.nlm.nih.gov/35979717/