NEUROENDOCRINE AXIS OF STRESS, METABOLIC SYNDROME AND PSYCHIATRIC DISORDERS IN CUSHING'S SINDROME

The role of abnormalities of the hypophysis-hypothalamus-adrenal gland axis (HHA) in the ongoing stress and depression is analyzed. Besides, it is evidenced that some problems, until recently considered merely endocrine-metabolic such as Cushing's syndrome (either clinical or subclinical) and obesity (mainly when it is part of the metabolic syndrome) may have a common etiological basis, be it a primary event, a comorbidity or a trigger in individuals with genetic susceptibility to states of maladaptative chronic stress. Some harmful effects of severe and/or ongoing hypercortisolism on some brain areas and the possibility of permanent alterations in some neuronal circuits are described. Finally, and according to some clinical evidences, the potential therapeutic role of antiglucocorticoids in the management of refractory depression is explored, as well as the role that early psychiatric intervention and antidepressant pharmacological treatment may play in some patients with the metabolic syndrome or increased cardiovascular risk.