Final Cumulative Paper: Psychiatric Symptoms of Cushing’s Disease

Cushing’s disease is a rare endocrinal disorder caused by excess producing of corticosteroids. In average,0.7-2.4 per million people are diagnosed with the disease each year. Most frequently, Cushing’s disease develops due to pituitary adenoma. Increased level of corticosteroids affects various body systems and causes a wide range of associated diseases and clinical manifestations. The most common related conditions are hypertension and related to it cardiovascular diseases, immune deficiency and infections development, musculoskeletal disorders, including myopathy, osteoporosis, and bones fractures, and psychiatric disorders. Even though the disorder is relatively rare, it affects significantly national economics due to significant costs required for treatment of Cushing’s disease itself and associated conditions. It is essential to diagnose the disease and to provide the adequate therapy for both saving costs and to improve patient’s quality of life. The most common mental disorder is major depression. Except for it, emotional liability, anxiety, irritability, sleep and appetite disorders, acute psychosis, and cognitive impairments can develop. These conditions caused difficulties in social and family life, performing work duties. Besides, major depression can lead to the suicide. This paper discusses the etiologic factors about Cushing’s disease and the health implications of the disease on both social and economic status of the affected people. Included is scientific research that involves clinical inquiry and findings on the disease prevalence, prevention, and treatment.

Cultural norms and values influence the mental state of patients suffering from the psychiatric symptoms of CD. There is no study, which directly shows the cultural factors influencing patients with CD-related psychiatric symptoms. This study considers other general cultural norms and values and their influence on the mental health state of a person with CD-related psychiatric symptoms. The article dubbed Psychiatric disorders associated with Cushing's syndrome by Bratek, A., Koźmin-Burzyńska, A., Górniak, E., and Krysta, K (2015) highlights the need to be alert in early detection of CD to avoid its misdiagnosis. After understanding the psychiatric disorders related to CD the ethical and cultural perspectives of CD-related psychiatric symptoms, the society can be able to manage the disease in its early.

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Final Cumulative Paper: Psychiatric Symptoms of Cushing’s Disease

The pituitary adenoma majorly causes Cushing's disease. Development of the tumor results in excess of adrenocorticotropic hormone (ACTH) which creates the excess exposure of hypercorticoidism or adrenal glucocorticoids.80% of people with Cushing’s diseases develop this type of disease. The disease equally develops due to adenoma or adrenal carcinoma in the rest of the population; this is the ACTH-independent Cushing’s disease (Feelders, Lacroix, Stratakis & Nieman 2015). It is thus necessary to put into consideration the general clinical findings of Cushing’s disease (Level 1 questions) and hence focus the attention on the psychiatric manifestations as one of the groups of symptoms (Level 2 questions).

Scientific Perspective of Inquiry

Level 1 Research Questions

Anatomical, Physiological, Pathological and Epidemiological issues of the Disease

The following anatomical structures are involved in the development of the Cushing’s disease: Pituitary, adrenal and pituitary adenoma responsible for the production of the ACTH (Lacroix et al., 2015). The following physiological processes are involved: the excess production of ACTH by the pituitary adenoma which leads to excess production of the glucocorticoids which subsequently affect the body system such as the reproductive, neurological, musculoskeletal, immunological and the cardiovascular systems, skin and body metabolism (Nieman, 2015). The various pathological conditions caused by the disease are the different clinical manifestations. Hypersecretion of corticosteroids causes metabolic dysfunction resulting in cardiovascular diseases, hypertension, diabetes, obesity, and dyslipidemia. Hormones affect the neural system resulting in emotional disorders and equally decreasing the cognitive abilities. Corticosteroids affect the musculoskeletal system causing bones to be of low density, fractures, and myopathy. Excess of the glucocorticoids suppresses the immunity and allows for infectious disease development (Nieman, 2015). Sharma, Nieman, and Feelers described the epidemiology of the disease (2015) with an annual incidence rate of 0.7-2.4 per million people. Cardiovascular diseases, severe infections, and suicide were the most common causes of death among these people with women developing the disease three times frequently than men (Lacroix et al.,2015).

Systematic, Cellular/Genetic and Chemical levels of the Disease

The organism’s primary endocrine system is affected. The neural, musculoskeletal, cardiovascular and immune networks and metabolism are changed due to the hormonal imbalance (Nieman, 2015). On the cellular level, glucocorticoids bind with specific glucocorticoid receptors (GR) that are located at the surface of the cell in almost all types of tissues. The Glucocorticoid Receptors (GR) is the nuclear receptors that are connected to the DNA molecule. The glucocorticoids have a stress-like action thus affecting various homeostatic and metabolic functions of the body (Kadmiel & Cidlowski, 2013). Perez-Rivas et al. (2015) did determine that an approximation of 36% of the people with the Cushing’s disease had a mutation in the USP8 gene (ubiquitin-specific protease gene) and this increases the probability of the development of the disease. However, Cushing’s disease is not a genetic disorder. Cushing’s disease is caused by the excess exposure of glucocorticoids hence the adrenal hormones are the very most important. Many of the body tissues produce receptors to glucocorticoids. The ACTH, a pituitary hormone, regulates the production of glucocorticoids thus the second most important compound in the development of the disease (Nieman, 2015).

The Mathematical and Scientific Perspective of Psychiatric Symptoms of Cushing’s Disease

Economic Issues and Theories

Medical cost spent on the treatment of people is the most critical economic issue involved with those with the Cushing’s disease (CD) having significantly higher consumption of medical services. CD is associated with multiple comorbidities. A patient suffering from numerous associated disorders has the substantial economic burden, and this requires significant healthcare costs. Secondly, CD needs a significant national budgetary spending since both the pharmaceutical and medical costs are covered by the Medicare and other government insurance programs. It is of great importance to put into consideration the effect of the disease treatment in that controlled disease (diagnosed and treated appropriately) is associated with significantly less costs than the uncontrolled diseases (Nellesen, Truong, Neary & Ludlam, 2016). There are no economic theories related to CD that have been found in the literature. In the investigations by Nellesen et al. (2016), the financial outcomes from the treatment of the illnesses were calculated as the difference in cost between the uncontrolled and controlled disease. This investigation did show that that uncontrolled disease annually requires $5836 per patient related to psychiatric illness, $ 5200 for osteoporosis and $ 4639 for the nephrolithiasis. The controlled infections are, however, associated with significant cost savings with the appropriate treatment being associated with saving of worth $ 4444, $ 2579 and $ 2200 for each of the diseases respectively.

Statistical Issues and Processes

Plenty of statistical facts related to Cushing’s disease are available. The rate of Cushing’s disease is 0.7-2.4 per million people annually. Women to men incidence ratio is 3:1, with an approximation of 80% of all conditions being ACTH-dependent and 20% being ACTH-independent (Lacroix et al., 2015). It is of equal importance to consider the statistics of the different comorbidities and the associated diseases. Prevalence of the various symptoms vary among the population with the following prevalence being of the most common related conditions: obesity-32-41%, diabetes 20-41%, hypertension 55-85%, dyslidemia 38-71%, osteoporosis 38-50%, Psychopathology -67%, major depression 55-80% atrophy of hippocampal tissue -27% (Sharma et al., 2015). In the estimation of risks and outcomes of Cushing’s disease, various statistical processes can be used. The different analytical procedures include the rate of the disease and each comorbidity measuring, morbidity and mortality, the rate of readmission and the rate of the positive outcomes of different treatments approaches such as medications, surgery, hormonal therapy and radiotherapy (Sharma et al., 2015).

Level 2 Research Questions

Scientific Perspective of Inquiry

Psychiatric Disorders Associated with Cushing’s Disease

There are several groups into which psychiatric disorders associated with Cushing’s disease can be divided. The prominent symptom for CD is the mood disorder. Other symptoms include mania, anxiety, bulimia, irritability, hypersomnia, depression and increased fatigue. People with the Cushing’s’ disease have cognitive impairments associated with difficulties with memory and concentration. Psychotic disorders, specifically acute psychosis is less common (Pivonello et al., 2015).

Anatomical and Cellular /Molecular Structures Involved

The psychiatric manifestation of CD just as other symptoms appears due to the excess production of glucocorticoids by the adrenal glands hence the adrenal glands play a crucial role the development of the symptoms. In most cases, hypercorticoidism is caused by the pituitary adenoma which is equally an essential anatomical structure (Nieman, 2015). The GRs are widely spread among the central nervous system majorly in the hippocampus hence excess of the glucocorticoids affects the structure of the brain leading to brain atrophy. Neurons, that is, hippocampal cells are thus the anatomical structures responsible for the development of psychiatric symptoms (Pivonello et al., 2015). Mechanisms accountable for brain atrophy are not known (Pivonello et al., 2015). Four main theories, however, exist in an attempt to explain the mechanisms responsible. First theory suggests that neurons atrophy is caused by glucose decreasing due to the metabolic impairments that are related to the Cushing’s disease. The second theory asserts that the excess of the glucocorticoids causes the increase of excitatory amino acids specifically the glutamate. Finally, glucocorticoids inhibit new neurons formation in the dentate gyrus, which leads to the decrease of hippocampus volume. These four mechanisms affected hypocampus and prefrontal cortex and cause neuropsychiatric disorders.

Mathematical/Analytical Perspective of Inquiry

The frequency of Psychiatric Symptoms

The rate of each psychiatric symptom can widely vary in the population. The most common disorder is depression. Major depressive disorders are observed in 50-70% of people with Cushing’s disease. The rate of anxiety is wide: 12-79% of cases. Hypomania is typical for 3% of people (Tang, O’Sullivan, Diamond, Gerard, & Campbell, 2013). Increased irritability is typical for 86% of patients. Increased fatigue is common for almost all people with Cushing’s disease. Two-third of people reported decreased libido. Appetite increase is typical for 34% of people, appetite decrease – for 20%, and sleep disorders – for 69%. The bipolar disorder develops in 30% of patients. Neurocognitive impairments were observed in two-thirds of the population. Finally, suicide is one of the death reasons for patients with Cushing’s disease. Suicide occurs due to severe depressive disorder. It was shown that suicidal thoughts were described for 17% of patients, and suicide attempts – for 5%. One must remember that this value is frequently minimized by patients (Pivonello et al., 2015).

Economic Consequences of Psychiatric Symptoms Development

It was shown by Nellesen et al. (2016) that psychiatric disorders are the most costly comorbidities of Cushing’s disease. Mental illnesses caused by uncontrolled Cushing’s disease cost $5836 for each patient annually. These costs are the sum of expenses spent on the comorbidity. It is the direct economic burden on a patient. Also, psychiatric disorders in people with Cushing’s disease are one of the leading factors that adversely affect the quality of life of these people. Mental and emotional disorder cause difficulties in social and family life and performing work duties. Job loss and difficulties with job finding are typical problems of people with Cushing’s disease, which provide an additional economic burden on them (Bratek, KozminBurzynska, Górniak, & Krysta, 2015).

Case Study 1

The study investigates the symptoms of CD and the complications of the infection through a review of materials and research that has been conducted by different clinical experts. The information presented in the literature reviews have been analysed and a search through the medical databases. The case reports of patients from various health facilities have been studied, and the results obtained discussed below. The case study includes an in-depth analysis of the symptoms and their effect on pregnant women have also been analysed.

Materials and Methods

Investigation of different types of symptoms, including psychiatric, in people with Cushing’s disease, is complicated due to the low rate of the infection (Lacroix et al., 2015). Most of the information regarding the topic is presented in literature reviews (Bratek et al., 2015; Pivonello et al., 2015). For these reviews, it is needed to perform a search in medical databases and review the statistics of psychiatric symptoms in patients with the disease. Secondly, to investigate psychiatric symptoms, it is possible to study separate patients and describe their symptoms, using case reports. In this case, no statistical analysis is likely due to the lack of the data. For example, Tang et al. (2013) described two case studies in their research article. The authors described symptoms, treatment, and further outcomes of patients.


Clinical manifestations of two patients described by Tang et al. (2013) are presented in the results. Among psychiatric symptoms of Cushing’s disease, major depression and depressive moods, psychotic features, in particular, auditory hallucinations and nihilistic delusion, anxiety, and insomnia were listed. The authors also stated that appropriate Cushing’s syndrome therapy improved the psychiatric condition of both patients (Tang et al., 2013). According to the results obtained, both patients had depressive moods without suicidal intent and auditory hallucinations. Thus, it is possible to suppose that these symptoms will be the most frequent among patients with Cushing’s disease. However, Pivonello et al. (2015) underlined that major depression was the most common psychiatric symptoms. The authors did not provide the statistics of psychotic features despite mentioning them in a list of symptoms. Thus, further investigations on the statistics related to Cushing’s disease psychotic syndromes are needed.

The Ethical & Cultural Perspective of Psychiatric Symptoms of Cushing’s Disease

The Cushing disease results from excess blood cortisol levels. This contributes to the formation of adrenocorticotropic hormone (ACTH)-benign tumor in one’s pituitary glands, referred to as pituitary adenoma according to Lamos & Munir (2014). The tumor leads to chronic excessive exposure to glucocorticoids, and this brings about Cushing’s disease. The condition CD is very rare yet difficult to diagnose. The difficulty in diagnosing CD is due to its characteristic overlapping symptoms with other diseases, making it be overlooked. Cushing’s disease frequently leads to neuropsychiatric disorders including, in particular, major depression. Because the disease severely afflicts people’s life, it is important to consider legal, ethical, and cultural aspects of its development and treatment. Regarding laws and regulations, PPACA, ADA, and FMLA protect people with Cushing’s disease in terms of medical insurance coverage and guarantee job security for employees with the CD (Fajuri, 2017). Ethical theories and various principles should be considered in studying the psychiatric symptoms resulting from CD. In particular, these studies should reflect the ethical principles of maximizing benefits and minimizing harm. It is also important to reconsider cultural norms and values in relation to Cushing’s disease since they influence mental state of patients with psychiatric symptoms of the CD. This study focuses on highlighting the ethical and cultural perspectives of psychiatric symptoms of the Cushing’s disease. It includes a review of the different laws that protect CD patients with psychiatric symptoms, the ethical theories/principles that can be used in studying the condition, and the cultural norms that influence the mental state of CD patients with psychiatric symptoms. This study will also review of the article Psychiatric disorders associated with Cushing's syndrome by Bratek, Koźmin-Burzyńska, Górniak, and Krysta (2015), including the methodology and the results of the research.

Level 2 Research Questions

Ethical Perspective of Inquiry

ADA & PPACA on Protection of Patients with Cushing’s Disease-related Psychiatric Symptoms

The Cushing’s disease presents with psychiatric symptoms in most cases. There is thus need for these patients to be classified as needing special protection by the Americans with Disabilities Act (ADA) as well as by the Patient Protection and Affordable Care Act (PPACA) (Fajuri, 2017). Both ADA and PPACA are regulations whose provisions are aimed at protecting people with disabilities including mental disabilities, as is the case for patients with the Cushing’s disease-related psychiatric disorders. In regard to the Americans with Disabilities Act (ADA), it is mandatory for every employer to provide medical insurance for all their employees, including people with Cushing’s disease (ADA National Network, 2017). In this regard, an employee who develops Cushing’s disease, which presents with psychiatric disorders, should still have their health employers remitting insurance premiums for them. This protects the patients from any fraudulent cancellation of their employer-provided health insurance covers in the wake of their psychiatric disorders.

Another provision of the ADA is that every employee that develops a disability is still guaranteed job security (ADA National Network, 2017). This means that employers are barred from firing an employee on the basis of having developed a disability such as the psychiatric symptoms that present in employees with Cushing’s disease. Therefore, psychiatric disorders resulting from the Cushing’s disease should not render an individual jobless. The ADA provisions thus protect these patients from any further depression that could herald from a lack of insurance cover, the burden of high medical bills and firing from work.

The Patient Protection and Affordable Care Act (PPACA) also play a major role in ensuring that people ailing from any given disease in America are protected as well as receive affordable healthcare. One of the main provisions of PPACA is that insurance companies cannot refuse to provide medical insurance coverage to a person, because of their pre-existing medical condition (, 2017). This means that patients with the Cushing’s disease also fall under the favor of this particular provision. They, therefore, have a right to be enrolled in their desired medical coverage from any given insurance company. Availability of access to health insurance coverage is very important as it helps the patients to have lesser and/or no depressive issues that could aggravate their psychiatric conditions. Further, according to (2017), PPACA gives a guarantee to any person who is not able to afford medical insurance to be enrolled in the Medicaid program.

Other related regulations that protect people with psychiatric conditions related to the Cushing’s disease include the Family and Medical Leave Act (FMLA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA). FMLA requires that an employee with a serious medical condition can have up to twelve weeks unpaid, job-protected leaf from work. If they do return to work, one might be eligible for Social Security Disability Insurance (, 2017). Patients with Cushing’s disease-related psychiatric symptoms can thus be given a leaf to recuperate, and this is likely to minimize their stress levels while still on treatment. According to COBRA, in case of leaving the job due to the health condition, a former employee has 60 days to purchase new insurance or to obtain insurance. COBRA allows a person to have the same insurance plan like the one before leaving the job, but he/she should pay the total premium. These acts thus fully support individuals suffering from the psychiatric symptoms of the Cushing’s disease.

Ethical Theories & Principles in Studying the Psychiatric Symptoms of Cushing’s Disease

Ethics regulates all spheres of human life, including healthcare. There are two main approaches to the medical ethics: deontological and utilitarian. Deontological ethics focuses on the patient’s benefits while utilitarian ethics addresses the benefits of the whole society. Ethical theories evolve in the medical research (Reddy & Mythri, 2016). The main obstacle to ethical standards in treating Cushing’s disease appears because it is a rare condition. Thus, it is not easy to conduct the medical study based on existing ethical principles. For example, it is time-consuming to create two groups for investigation (intervention and control) and to apply statistical methods for analyzing obtained data. Thus, institutional review board should approve design of medical research on people with Cushing’s disease.

In case of Cushing’s disease treatment, deontological ethics is more appropriate. The services provided by healthcare workers should lead to patient’s health state improvement. In fact, there are four main ethical principles of medical care, which could relate to Cushing’s disease: the principle of non-maleficence or doing no harm, beneficence, respect for autonomy, and fair treatment for everyone (Reddy & Mythri, 2016). Thus, deontological ethics addresses both the studies dedicated to Cushing’s disease and the treatment of this condition.

Medical research should be performed in accordance with such ethical principles as informed consent, non-exploitation, privacy and confidentiality, risk minimization, professional competence, transparency, maximization of public interests, and total responsibility (Avasthi, Ghosh, Sarkar, & Grover, 2013). However, some of these principles are difficult to consider during the studies on psychiatric disorders. First, people with mental illnesses frequently have impaired cognition and emotional state. These impairments are typical for people with Cushing’s disease (Pivonello et al., 2015). Thus, it can be difficult to obtain credible information and to make a person completely understand the objectives of the research. Second, new therapeutic approaches, which could potentially be harmful to patients, are often applied for the treatment of mental illnesses. To address these issues, the specialists should correspond to the utilitarian ethical theory (Avasthi et al., 2013). It means that before starting the study, the researchers should develop an elaborate plan that can maximize the potential benefits and minimize the risks of their intended study on CD related psychiatric symptoms.

Level 2 Research Questions

Cultural Perspective of Inquiry

Culture comprises a set of beliefs, values and even norms that are shared by a group (Lewis, 2016). Cultural norms of a given community affect largely, the mental state of people suffering from Cushing’s disease. Currently, barely any study has directly focused on highlighting cultural norms that affect people with the Cushing’s disease. Even so, there are studies that have established common cultural norms that can affect people mentally and determine their mental state. People with the Cushing’s syndrome are thus also likely to have their mental state affected by different cultural norms. According to the Yorke, C., Voisin, D., Berringer, K., & Alexander, L (2015), cultural norms and values influence the different ways in which patients from a given culture express and/or manifest their symptoms, coping style, family support, and health-seeking behavior. The culture of a clinician, as well as that of the service system, determines disease diagnosis, treatment and health service delivery.

First, in regard to race and ethnicity, it is clear that mental health disorders are still highly prevalent in every race (Yorke et al., 2015). This includes the case of Cushing’s disease-related mental problems. Considering that, mental health problems are caused by complex factors involving social, biological, psychological and cultural factors, the strength of these factors in a patient depends on the specific mental disorder (Mackenbach, 2014). Concerning races, the Cushing's disease occurs in every race but affects more women as compared to men (ratio of 3:1). It is, however, a rare disease globally. Race and ethnicity thus do not influence Cushing’s syndrome unless other economic and social factors come into play.

Secondly, social and economic inequality influences the mental state of people with psychiatric conditions from different ethnic and racial minority groups. This is the case of the US, where minority groups are exposed to social and economic inequalities (Yorke et al., 2015). These include but not limited to racial discrimination, poverty, and violence. A patient from such background suffering from the Cushing’s disease is more likely to have no medical insurance cover, low wages to sustain self and family, and thus aggravating their psychiatric symptoms (Nellesen, Truong, Neary, & Ludlam, 2016). These groups undergo additional depression and anxiety, making patients with diseases to have escalated mental health problems.

A third cultural norm or factor that influences the mental state of people with psychiatric conditions include stigma (Yorke et al., 2015). Stigmatization of people with Cushing’s disease and related psychiatric conditions can heighten the condition among patients. Stigma is likely to make an individual patient ignore or refuse to seek help when in need (Lewis, 2016). It is also apparent that minority groups have a more unfavorable attitude towards people with mental illness as compared to whites in the American setting.

Further, some communities and families have mistrust particularly in the mental health services (Lewis, 2016). This completely deters people especially from minority groups in America from seeking treatment. This is especially based on their establishment that there is a high likelihood of direct and/or indirect bias and stereotyping by clinicians. Patients with the Cushing’s disease presenting with mental health challenges from such backgrounds are likely to avoid treatment and have their condition worsened.

Case Study 2

Ethical and cultural factors play an important role in both studying and the management of patients with psychiatric symptoms of Cushing’s disease. Patients with the Cushing’s disease suffer a condition referred to as the Cushing’s syndrome, which presents with symptoms described as hypercortisolism. Hypercortisolism is an endocrine disorder involving over-secretion of the adrenocorticotropic Hormone. The disorder leads to various psychiatric comorbidities. These include among others, mood, psychotic, anxiety disorders, and cognitive dysfunctions. A recent study carried out by Bratek et al. (2015) established the psychiatric disorders, which are associated with the Cushing's syndrome. More specifically, the researchers aimed at establishing the prevalence, particular symptoms, and the consequences of psychiatric disorders especially in the course of the Cushing's syndrome. The results of this study are a rich source of information particularly for any study aimed at relating ethical and cultural factor influence on the mental state of patients with Cushing’s disease-related psychiatric symptoms.


The researchers carried out a thorough literature review by use of keywords to extract secondary information sources. Among the keywords used to sear and extract relevant data included: Cushing's syndrome and psychosis, Cushing's syndrome and depression, Cushing's syndrome, and mental disorders, and further, Cushing's syndrome and anxiety (Bratek et al., 2015). After reviewing the secondary qualitative data using grounded and content analysis approaches, the researchers presented the results of the study.


After the study, Bratek et al. (2015) established that depression is the most prevalent among the psychiatric comorbidities of Cushing's syndrome. The rest included; mood, psychotic, anxiety disorders, and cognitive dysfunctions. The study also found out that psychiatric manifestations most likely precede full-blown Cushing's syndrome onset and this can lead to misdiagnosis of the condition. Further, the study established that while treating the underlying endocrine disease can mostly alleviate psychiatric symptoms, there is a persistent loss of a patient’s brain volume. In concluding their study, Bratek et al. (2015) found that it is very important for caregivers including families and healthcare teams to be alert to hypercortisolism symptoms in psychiatric patients. This can help in avoiding misdiagnosis and thus enable the patients to receive required adequate treatment.


The above study has outlined the ethical and cultural perspectives of psychiatric symptoms of the Cushing’s syndrome. From the study, healthcare regulations including ADA and PPACA protect individuals with the psychiatric symptoms of CD from any possible denial of medical insurance. They also guarantee these patients job security particularly for employed patients. The deontological and utilitarian theories among other ethical principles discussed here can help in studying psychiatric symptoms of patients with CD. Regarding the cultural norms that influence the mental state of patients suffering from the psychiatric symptoms of Cushing’s disease, it is clear that no study has been done to establish this information. However, there are studies that generally outline the cultural norms that influence the mental state of people with all mental health problems. This means that psychiatric symptoms of CD are also included among the disorders influenced by cultural norms and values that determine; how patients from a given culture express and/or manifest their symptoms, coping style, family support, and health-seeking behavior. The culture and values of specific practitioners, as well as that of the service system, determine disease diagnosis, treatment and health service delivery. The review of the article Psychiatric disorders associated with Cushing's syndrome by Bratek, A., Koźmin-Burzyńska, A., Górniak, E., and Krysta, K (2015), highlighted the need to be alert in early detection of CD and avoidance of its misdiagnosis. By understanding psychiatric disorders related to CD, the ethical, and cultural perspectives of CD-related psychiatric symptoms, the society can be able to manage the disease in its early stages and even later. There is, however, a need for researchers to delve into establishing the exact cultural norms and values that influence the mental state of patients presenting with psychiatric symptoms of the CD.

Cushing’s disease is rare but heavy medical condition associated with hypercorticoidism. To understand the disease, it is essential to consider the general scientific and mathematical issue related to it and to focus on one particular problem that is psychiatric disorders associated with Cushing’s disease. Early detection and treatment of the disease are fundamental for the prognosis of the course of management strategies. The only problem that practitioners still battle with is the difficulty of detection of the disease since most of the symptoms overlap those of other conditions. Delayed detection implies late treatment which inhibits effectiveness in contact and preventing further spread of the disease. Notably, the pregnant women are likely to suffer most from the condition since the disease leads to hypertension, diabetes mellitus, heart failure, preeclampsia, and other severe illness which may ultimately cause death. One of the proven ways of solving the situations is early proper diagnosis and commencement of treatment immediately. Healthcare providers must also brace themselves with the right competencies concerning the disease to improve their vigilance and promptness in the diagnosis process. The secret to containing Cushing Disease is in ensuring successful diagnosis and early treatment. Priority ought to be given to pregnant women due to the severity of the consequences on them during such periods.