Mental health challenges, poor sleep drive night eating in Cushing’s

People with Cushing’s disease often do an unusual amount of eating at night — but this behavior is driven mainly by mental health challenges and sleep disturbances, not because of the hormonal imbalance that underlies the disease.

That’s according to a study, “Night eating in Cushing’s disease: Disentangling psychological, sleep, and endocrine contributions,” published in Psychoneuroendocrinology.

“Within the [Cushing’s disease] cohort, night eating severity was not associated with cortisol biomarkers, and [hormone-related] parameters did not differ between patients with and without night eating syndrome,” the researchers wrote. “Instead, [statistical] analyses indicated that psychological distress—reflected by depression and anxiety scores—and sleep disturbance were the main independent correlates of night eating severity.”

That suggests “that night eating behaviors in [Cushing’s disease] may be more strongly linked to psychological and sleep-related mechanisms than to the degree of biochemical hypercortisolism [high cortisol] itself,” they added.

Cushing’s is caused when a tumor in the brain’s pituitary gland results in excessively high levels of the stress hormone cortisol due to a tumor in the brain’s pituitary gland. High cortisol levels drive Cushing’s symptoms such as skin changes, weight gain, and mental health issues.

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Night eating refers to abnormal behaviors where a person eats a lot at night and very little in the morning. In extreme cases, this can qualify as a psychiatric diagnosis, referred to as night eating syndrome.

Previous studies have suggested that people with Cushing’s disease may be more likely than the general population to engage in night eating behaviors. But what makes people with this disease more likely to seek out a midnight snack?

To find out, researchers in Turkey studied 55 people with Cushing’s disease and 43 healthy controls. All participants completed a standardized assessment of night eating symptom severity, the Night Eating Questionnaire. Participants also completed various questionnaires about mental health and sleep habits, and had their cortisol levels measured.

The researchers found that those with Cushing’s disease tended to report more night eating symptoms than healthy controls: Approximately 16% of the Cushing’s patients met criteria for NES, compared with fewer than 5% of healthy controls. Night eating also tended to be more severe in patients with active Cushing’s than in those whose disease was in remission.

Using mathematical models, the researchers looked for statistical associations between night eating symptom severity and other metrics. This revealed strong correlations between night eating, mental health, and sleep. In other words, patients who displayed more night eating behaviors also generally reported worse anxiety and depression, as well as poorer sleep. By contrast, there was no clear link between cortisol levels and night eating symptoms. Body mass index (BMI, a ratio of weight to height) was likewise not strongly linked with night eating severity.

“Psychological distress and sleep disturbance, rather than [cortisol] markers, independently predicted night eating symptoms in the [Cushing’s disease] cohort,” the researchers concluded.

The findings imply that if night eating behaviors are causing problems for people with Cushing’s, psychological and sleep support may be the most effective interventions, the researchers said. They urged further studies to determine how best to support patients in need.