Increased Prevalence of Anxiety-Associated Personality Traits in Patients with Cushing’s Disease: A Cross-Sectional Study

Background/Aims: Chronic hypercortisolism in Cushing’s disease (CD)
hasbeen suggested to contribute to an altered personality profile
in thesepatients. We aimed to test this hypothesis and attempted to
determinethe effects of disease- and treatment-related factors that
mightmoderate an altered personality in CD. Methods: We assessed 50
patientswith CD (74% biochemically controlled) and compared them to
60 patientswith non-functioning pituitary adenomas (NFPA) and 100
age-andgender-matched mentally healthy controls. Personality was
measured bytwo standardized personality questionnaires, TPQ
(Cloninger PersonalityQuestionnaire) and EPQ-RK (Eysenck
Personality Questionnaire-RK).Results: Compared to mentally healthy
controls, CD patients reportedsignificantly less novelty-seeking
behaviour, including less exploratoryexcitability and less
extravagance. On harm avoidant subscales, theypresented with more
anticipatory worries and pessimism, higher fear ofuncertainty,
shyness with strangers, fatigability and asthenia.Moreover, CD
patients appeared to be less extraverted, more neurotic andsocially
desirable. CD patients differed from NFPA patients in terms
ofhigher neuroticism scores, and NFPA patients did not show
alterednovelty-seeking behaviour or extraversion. In the subgroup
analysis, CDpatients with persistent hypercortisolism displayed
significantly higherfear of uncertainty, fatigability and asthenia,
indicating high harmavoidance in total, than those in biochemical
remission. Conclusion:Patients with CD showed a distinct pattern of
personality traitsassociated with high anxiety in combination with
traits of lowexternalizing behaviour. Such personality changes
should be taken intoaccount in the diagnosis and treatment of CD
patients, as they mightinterfere with the patient-physician
communication and/or challenge thepatients’ social and
psychological functioning.