Steroids and stress in CSC

Research seeks clues that will elucidate disease pathogenesis

Cheryl Guttman Krader

Posted: Friday, March 1, 2019

Elon H C van Dijk

Available evidence indicates that stress and hypercortisolism are involved in the pathogenesis of central serous chorioretinopathy (CSC), but more research is needed to understand the underlying pathways and the implications for patient management, Elon H C van Dijk MD, PhD, told during a session of the 18th EURETINA Congress in Vienna.

He presented findings from a study designed to explore questions related to hypercortisolism and stress in patients with CSC. The study included 88 patients with CSC and 24 controls. It investigated whether patients with CSC might have subclinical hypercortisolism or oligosymptomatic Cushing’s syndrome. In addition, it sought to evaluate psychological stress and coping mechanisms in patients with CSC and identify if they had specific personality traits as previous reports suggested that people with a “type A” personality were at increased risk to develop CSC.

Patients included in the study had a diagnosis of CSC established by multimodal imaging within the past two years and no history of corticosteroid use before or after developing CSC. Evaluations included clinical examination, assays of cortisol levels in hair, serum, a 24-hour urine collection, saliva and a dexamethasone suppression test.

Results indicated that activity of the hypothalamus-pituitary-adrenal axis was increased in the patients with CSC. None of the patients with CSC had evidence of subclinical Cushing’s syndrome, reported Dr van Dijk, Leiden University Medical Centre, Leiden, the Netherlands.

“We previously published that CSC can be the first manifestation of Cushing’s syndrome. Based on our new study, we think that unless patients with CSC have signs or symptoms of Cushing’s syndrome, they do not need to be referred to an endocrinologist as a routine screening measure. The importance of hyperactivity of the hypothalamus-pituitary-adrenal axis in our patients is not known, but warrants further studies.”

Stress, coping, and personality traits were evaluated using several validated questionnaires. Analyses showed that the personality profile of the patients with CSC was more similar to that of patients treated for Cushing’s disease than to the general population. No difference in perceived stress was found comparing subgroups of CSC patients who had active and inactive disease, based on either the presence or absence of subretinal fluid on the optical coherence tomography scan. Results regarding stress coping indicated that patients with CSC sought more social support than healthy controls and used more active and passing coping. CSC patients, however, were not found to be abnormal in stress coping.

“Based on these findings, we believe there is no clear role for stress reduction in the treatment of CSC,” said Dr van Dijk.

Elon H C van Dijk:

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