St. Vincent’s Hospital, Richmond Rd., Fairview, Dublin 3, Ireland.
Stress. 2001 Jun;4(2):91-119. doi: 10.3109/10253890109115725.
Striking similarities exist in the endocrinology of Cushing's disease and melancholic depression.Laboratory abnormalities, which have been found in both, include raised urinary,plasma and salivary cortisol, non-suppression of cortisol in the dexamethasone suppression test and adrenocorticotrophin (ACTH) hypersecretion. The hypercortisolism can be so severe in melancholic depression that it is difficult to distinguish from Cushing's disease and has been described as a "pseudo-Cushing's" state. Cerebrospinal fluid corticotrophin-releasing hormone (CRH) levels have been found to be lower in patients with Cushing's disease than in depressed subjects. Dynamic endocrine tests may help to distinguish between the two disorders.An exaggerated response to synacthen has been found in both but a reduced ACTH response to CRH occurs in depression, unlike those with Cushing's disease who show ACTH hyper-responsiveness. Other tests, which may help to distinguish between the two disorders,include the dexamethasone-CRH test, the naloxone test, the insulin-induced hypoglycemia test and the desmopressin stimulation test. Similarities in psychiatric symptoms have been recognised for many years. More recently, the physical complications of melancholic depression have been noted. These include osteoporosis, an increased risk of death from cardiovascular disease, hypertension, a redistribution of fat to intra abdominal sites and insulin resistance. Cushing's disease shares these physical complications and we propose that the common underlying factor is excessive plasma glucocorticoids. The increasing recognition of the physical complications and the increased morbidity and mortality in those who suffer from depression underscores the necessity for early detection and treatment of this illness and screening for undetected physical complications.
库欣病和抑郁症的内分泌学有明显的相似之处。这两种疾病都存在实验室异常，包括尿皮质醇、血浆皮质醇和唾液皮质醇升高，地塞米松抑制试验中皮质醇不抑制以及促肾上腺皮质激素（ACTH）分泌过多。抑郁症患者的皮质醇过多可能非常严重，难以与库欣病区分，并且已经被描述为“假性库欣状态”。已发现库欣病患者的脑脊液促肾上腺皮质激素释放激素（CRH）水平低于抑郁患者。动态内分泌测试可能有助于区分这两种疾病。在这两种疾病中都发现了对 synacthen 的过度反应，但在抑郁症中，ACTH 对 CRH 的反应降低，而库欣病患者则表现出 ACTH 过度反应。其他可能有助于区分这两种疾病的测试包括地塞米松-CRH 测试、纳洛酮测试、胰岛素引起的低血糖测试和去氨加压素刺激测试。多年来，人们已经认识到精神病症状存在相似之处。最近，人们注意到了抑郁症的身体并发症。这些包括骨质疏松症、死于心血管疾病的风险增加、高血压、脂肪向腹部内部转移以及胰岛素抵抗。库欣病也存在这些身体并发症，我们提出共同的潜在因素是过多的血浆糖皮质激素。越来越多的人认识到身体并发症以及患有抑郁症的人发病率和死亡率增加，这突显了早期发现和治疗这种疾病以及筛查未发现的身体并发症的必要性。
