SAT-024 - Determinants of Psychological Distress and Quality of Life in Cushing'S Syndrome: The Central Role of Fatigue and Body Perception

Introduction: Cushing’s Syndrome (CS) is a rare disorder resulting from chronic exposure to excess glucocorticoids, associated with significant physical and psychological morbidity. Understanding the profile of CS patients is crucial for optimizing long-term care. This study investigates the factors influencing psychological distress and quality of life (QoL) with a focus on the roles of fatigue and body perception.

Methods: This cross-sectional study included individuals aged 18 to 60 years with endogenous CS irrespective of etiology and activity status, recruited from a tertiary hospital in Southern Brazil. Diagnosis was established by endocrinologists, and data collection was conducted by a psychologist using the following instruments: Sociodemographic and Clinical Structured Interview, Hospital Anxiety and Depression Scale, Fatigue Impact Scale, World Health Organization QoL-bref, Multidimensional Body Self-Relations Questionnaire - Appearance Scales, and CushingQoL Questionnaire. Spearman correlation was calculated between instruments, and a Mann-Whitney U test was performed to assess differences between the active disease and remission groups, as well as between Cushing’s disease and CS.

Results: The sample (30 women and 3 men, mean age 44.96 ± 12.2 years) included 26 participants with Cushing's Disease (11 active, 22 remission). The mean time from symptom onset to diagnosis was 13 months, with 11.5 years mean follow-up. Regarding clinical correlations, fatigue impact showed a significant positive correlation with anxiety (ρ=0.438, p=0.011), depression (ρ=0.533, p=0.001), and distress (ρ=0.563, p< 0.001). Fatigue also correlated negatively with physical QoL (ρ=-0.427, p=0.013). Regarding body image, appearance evaluation showed strong positive correlations with psychological QoL (ρ=0.743, p< 0.001) and Cushing QoL (ρ=0.435, p=0.011). Conversely, lower body areas satisfaction was linked to increased fatigue impact (ρ=-0.579, p< 0.001), and overweight perception correlated negatively with psychological QoL (ρ=-0.482, p=0.005). Finally, the specific Cushing QoL showed robust negative correlations with depression (ρ=-0.672, p< 0.001) and distress (ρ=-0.677, p< 0.001). The results did not differ significantly between the remission/active phase, or between CD/other etiologies.

Conclusion: The findings highlight that in female patients with significant diagnostic delay, fatigue and body image dissatisfaction might be the primary drivers of psychological distress, and reduced specific QoL, which is strongly correlated with mental health indicators. The lack of significant differences between etiology and activity status underscores the persistent long-term psychological and QoL burden even after biochemical control, and emphasizes the need for multidisciplinary interventions that address both functional and emotional burdens.

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