Widespread reductions of white matter integrity in patients with long-term remission of Cushing's disease

• Published in: NeuroImage clinical Vol. 4; no. C; pp. 659 - 667
• Main Authors: van der Werff, Steven J.A., Andela, Cornelie D., Nienke Pannekoek, J., Meijer, Onno C., van Buchem, Mark A., Rombouts, Serge A.R.B., van der Mast, Roos C., Biermasz, Nienke R., Pereira, Alberto M., van der Wee, Nic J.A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.01.2014; Elsevier
• Subjects: Adolescent; Adult; Anisotropy; Cingulum; Cognition Disorders - etiology; Corpus callosum; Cortisol; Cushing Syndrome - complications; Cushing Syndrome - pathology; Cushing's disease; Diffusion Tensor Imaging; Female; Humans; Hypercortisolism; Image Processing, Computer-Assisted; Male; Middle Aged; Mood Disorders - etiology; Neuropsychological Tests; Psychiatric Status Rating Scales; Psychometrics; Radiology; Recurrence; Severity of Illness Index; Statistics as Topic; Uncinate fasciculus; White Matter - pathology; Young Adult; Hypercortisolism; Cushing's disease; Cingulum; Cortisol; Uncinate fasciculus; Corpus callosum; Diffusion tensor imaging
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2014.01.017

Hypercortisolism leads to various physical, psychological and cognitive symptoms, which may partly persist after the treatment of Cushing's disease. The aim of the present study was to investigate abnormalities in white matter integrity in patients with long-term remission of Cushing's disease, and their relation with psychological symptoms, cognitive impairment and clinical characteristics. In patients with long-term remission of Cushing's disease (n=22) and matched healthy controls (n=22) we examined fractional anisotropy (FA) values of white matter in a region-of-interest (ROI; bilateral cingulate cingulum, bilateral hippocampal cingulum, bilateral uncinate fasciculus and corpus callosum) and the whole brain, using 3T diffusion tensor imaging (DTI) and a tract-based spatial statistics (TBSS) approach. Psychological and cognitive functioning were assessed with validated questionnaires and clinical severity was assessed using the Cushing's syndrome Severity Index. The ROI analysis showed FA reductions in all of the hypothesized regions, with the exception of the bilateral hippocampal cingulum, in patients when compared to controls. The exploratory whole brain analysis showed multiple regions with lower FA values throughout the brain. Patients reported more apathy (p=.003) and more depressive symptoms (p<.001), whereas depression symptom severity in the patient group was negatively associated with FA in the left uncinate fasciculus (p<0.05). Post-hoc analyses showed increased radial and mean diffusivity in the patient group. Patients with a history of endogenous hypercortisolism in present remission show widespread changes of white matter integrity in the brain, with abnormalities in the integrity of the uncinate fasciculus being related to the severity of depressive symptoms, suggesting persistent structural effects of hypercortisolism. •We study white matter integrity in patients in remission of Cushing's disease.•The patients were compared to matched controls on fractional anisotropy (FA) values.•We found widespread reductions of FA after exposure to hypercortisolism.•Depression severity was related to FA in the left uncinate fasciculus in patients.