Cowden syndrome (also known as Cowdens disease and multiple hamartoma syndrome) is an autosomal dominant inherited condition characterized by benign overgrowths called hamartomas as well as an increased lifetime risk of breast, thyroid, uterine, and other cancers. It is often underdiagnosed due to variability in disease presentation, but 99% of patients report mucocutaneous symptoms by age 20–29. Despite some considering it a primarily dermatologic condition, Cowdens syndrome is a multi-system disorder that also includes neurodevelopmental disorders such as macrocephaly.The incidence of Cowdens disease is about 1 in 200,000, making it quite rare. Furthermore, early and continuous screening is essential in the management of this disorder to prevent malignancies. It is associated with mutations in PTEN on 10q23.3, a tumor suppressor gene otherwise known as phosphatase and tensin homolog, that results in dysregulation of the mTOR pathway leading to errors in cell proliferation, cell cycling, and apoptosis. The most common malignancies associated with the syndrome are adenocarcinoma of the breast (20%), followed by adenocarcinoma of the thyroid (7%), squamous cell carcinomas of the skin (4%), and the remaining from the colon, uterus, or others (1%). Signs and symptoms
As Cowdens disease is a multi-system disorder, the physical manifestations are broken down by organ system:
Skin
Adolescent patients affected with Cowden syndrome develop characteristic lesions called trichilemmomas, which typically develop on the face, and verrucous papules around the mouth and on the ears. Oral papillomas are also common. Furthermore, shiny palmar keratoses with central dells are also present.
Risk factors
Endogenous depression occurs as the results of an internal stressor—commonly cognitive or biological—and not an external factor. Potential risk factors include these cognitive or biological factors. Patients with endogenous depression often are more likely to have a positive family history of disorders and fewer psychosocial and environmental factors that cause their symptoms. A family history of depression and perceived poor intimate relationships are internal risk factors associated with this type of depression. It is important to know these risk factors in order to take steps to recognize and help prevent this illness. Treatment
Clinicians generally favor treatments such as antidepressant and mood-stabilizing medication and electroconvulsive therapy (ECT). ECT is an effective treatment option for endogenous depression. Both medication and ECT can be used in the short-term to treat acute episodes of endogenous depression, and in the long-term to reduce the risk of recurrence. During the first two decades of the 21st century, a new promising alternative/adjunctive depression treatment method known as transcranial magnetic stimulation, or TMS as its more commonly known, has become available. Prevalence
This type of depression often occurs due to biological reasons. Since symptoms are due to an internal phenomena, prevalence rates tend to be higher in older adults and more prevalent among women. Although endogenous depression has been associated with increased age, there have been few attempts to evaluate this fully. More research is needed to indicate factual prevalence rates on this type of depression in society. History
Endogenous depression was initially considered valuable as a means of diagnostic differentiation with reactive depression.