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