CASE REPORT Psychosocial morbidity in Cushing disease: a study from India Surendra Kumar Mattoo Æ Anil Kumar Bhansali Æ Nitin Gupta Æ Sandeep Grover Æ Rama Malhotra Received: 26 January 2009 / Accepted: 27 February 2009 / Published online: 9 April 2009 Ó Humana Press 2009 Abstract The main objective of this article is to study the psychosocial profile of patients of Cushing disease (CD) in a developing country setting. Eighteen patients with CD underwent a cross-sectional assessment regarding their socio-demographic and clinical profile, life events, social support, coping, dysfunction, quality of life, and psychi- atric morbidity. Twenty-two demographically group-mat- ched healthy participants (free from psychological morbidity) acted as the control group. The CD group had predominance of females (71.5%) with mean age at onset of 20.38 (range 8–38) years, and mean duration of illness of 65.33 (range 4–260) months. Six subjects (i.e., GHQ positive group) scored positive on the General Health Questionnaire-12 giving a psychological morbidity rate of 33.33%, with one having an ICD-10 diagnosis. There was no difference between GHQ positive and GHQ negative groups on number of life events, social support, quality of life and dysfunction. However, GHQ positive group used significantly more of internalizing coping strategies. Psy- chological morbidity occurs in a significant percentage of patients with CD. Presence of psychological morbidity is associated with internalizing coping strategies. Keywords Cushing disease Á Psychological morbidity Á Quality of life Á Coping Á Dysfunction Introduction With a prevalence of endogenous Cushing syndrome at 2–13 per million cases [1, 2], the Cushing disease (CD) is a chronic debilitating illness with neuropsychiatric manifes- tations in 85–100% cases [3, 4] and often marked distur- bance in physical appearance [3, 5]. Among psychiatric manifestations, the common ones are emotional instability, depression, anxiety, sleep disruption, and cognitive impairments [3, 4, 6, 7] and rare ones are psychosis and mania [8, 9]. The depression seen in CD is quite frequently has atypical manifestations [7]. The psychiatric manifes- tations may be attributable to the hormonal/biochemical changes [10–12], but the role of psychosocial stress induced by the pervasiveness of clinical features and body disfigurement may be equally or more important. CD has been reported to impact everyday living and impair marital, family, and work functioning [3], and affect the quality of life [13]. The available research being sparse and almost all from the western or developed countries, and the psychosocial milieu of the developing countries possi- bly being more severely stigmatizing for disfigurement [14], this research was planned as a cross-sectional study of psychosocial profile of CD in India, a developing country. Materials and methods Setting The study was carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh, a multi- speciality teaching tertiary-care referral hospital providing services to a major area of north India and catering to approximately 40 million people. S. K. Mattoo (&) Á N. Gupta Á S. Grover Á R. Malhotra Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India e-mail: skm_ddtc@glide.net.in A. K. Bhansali Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India Endocr (2009) 35:306–311 DOI 10.1007/s12020-009-9182-2