Cushing's Syndrome as a Family Disease

Substance addiction is widely recognized as an illness today, however, among the substances that can be the basis for addiction are corticosteroids, the synthetic form of the primary human stress hormone cortisol. There is mounting evidence for the contribution that excess corticosteroids have in the processes of addiction. It is readily noted within recovery programs that addiction is a family disease, but the psychoneuroendocrinological perspective of that statement is not well understood by many professionals. It is however well noted that the disease of addiction readily spreads throughout the family tree if left unchecked. The reality is that facing addiction in a loved one is one of the most stressful experiences in life, particularly when experienced by a child. The prolonged stress of that experience, particularly as a child's brain forms, physically changes the internal anatomy of the brain in a measurable way. It was Dr Owen Wolkowitz that first described the four ways in which the hippocampal region of the brain was volumetrically shrunken in the presence of excess levels of glucocoticoids such as cortisol and Prednisone. The hippocampus is the region of the brain that helps to regulate emotions and executive function. A reduced hippocampal volume has been associated with the narcissitic traits and defense mechanisms of psychopaths, and a longitudinal study of patients with endogenous Cushing's Syndrome showed an almost seventeen fold greater incidence of psychopathic behaviors before corrective surgery than the general population. It was also noted that after corrective surgery, and as the cortisol levels returned to normal, that the hippocampal regions of the patients brains began to rebound in volume while narcissistic and psychopathic behaviors also subsided. The hippocampus is the one region of the brain where new brain cells can grow provided that they are not exposed to excess levels of corticosteroids.  


The stress of being in the long term presence of addiction causes harm to the hippocampal regions of the brain of those nearest to the addict and a loss of their emotional sobriety. This frequently progresses to maladaptive behaviors such as substance addiction in an effort to avoid all of the painful emotional feelings. Turning our focus back to Cushing's syndrome regardless of which form, helps us to understand from the perspective of addiction, the loss of emotional sobriety in these patients for the same reasons as addicts to substances, which may also include corticosteroids, lose emotional sobriety.  It is important to note that Cushing's Disease, the endogenous form of Cushing's Syndrome, is not a substance addiction related condition, but because of the commonality of neurological changes in the brain, behavioral and personality changes with the substance related conditions of exogenous and pseudo Cushing's Syndrome, there would be benefits to both the patient and their support systems to consider it from that perspective.