open access
Assessment of brain and hippocampal volume in patients with Cushing’s disease
Affiliations- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
- Department of Radiology, Medicover Hospital, Warsaw, Poland
- Department of Neurosurgery, Military Institute of Medicine, Warsaw, Poland
open access
Abstract
Introduction: The purpose of this study was to assess the volumes of the hippocampus, grey matter, and the whole brain in patients with active Cushing’s disease compared to a control group.
Material and methods: We included 36 patients diagnosed with Cushing’s disease, with pituitary magnetic resonance imaging (MRI) performed as a standard preoperative assessment. The sample size of the control group was 26 persons. MRI studies were acquired with a 3.0 Tesla MR scanner equipped with a 24-channel head coil. The MRI study protocol included a pre-contrast 3D T1-weighted gradient sequence. Volumetric segmentation of the brain structures was performed using version 6.0 of the FreeSurfer software.
Results: We observed statistically significant reduction in the grey matter volume in the study group as compared to the control group (p < 0.001), with no significant differences in the volume of the whole brain (p = 0.104), left hippocampus (p = 0.790), and right hippocampus (p = 0.517). There was a strong positive correlation between grey matter volume and brain volume (r = 0.75, p < 0.001), independent of the study group.
Conclusions: The study showed unevenly distributed brain atrophy in patients suffering from Cushing’s disease, with no significant hippocampal atrophy. Significant atrophy was observed within the grey matter, potentially constituting a preliminary stage of whole-brain atrophy.
Abstract
Introduction: The purpose of this study was to assess the volumes of the hippocampus, grey matter, and the whole brain in patients with active Cushing’s disease compared to a control group.
Material and methods: We included 36 patients diagnosed with Cushing’s disease, with pituitary magnetic resonance imaging (MRI) performed as a standard preoperative assessment. The sample size of the control group was 26 persons. MRI studies were acquired with a 3.0 Tesla MR scanner equipped with a 24-channel head coil. The MRI study protocol included a pre-contrast 3D T1-weighted gradient sequence. Volumetric segmentation of the brain structures was performed using version 6.0 of the FreeSurfer software.
Results: We observed statistically significant reduction in the grey matter volume in the study group as compared to the control group (p < 0.001), with no significant differences in the volume of the whole brain (p = 0.104), left hippocampus (p = 0.790), and right hippocampus (p = 0.517). There was a strong positive correlation between grey matter volume and brain volume (r = 0.75, p < 0.001), independent of the study group.
Conclusions: The study showed unevenly distributed brain atrophy in patients suffering from Cushing’s disease, with no significant hippocampal atrophy. Significant atrophy was observed within the grey matter, potentially constituting a preliminary stage of whole-brain atrophy.
Keywords
Cushing’s disease; hypercortisolism; hippocampal atrophy; brain atrophy; magnetic resonance imaging
About this articleTitle
Assessment of brain and hippocampal volume in patients with Cushing’s disease
Journal
Issue
Article type
Original paper
Pages
823-830
Published online
2022-09-05
Page views
3973
Article views/downloads
389
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2022;73(5):823-830.
Keywords
Cushing’s disease
hypercortisolism
hippocampal atrophy
brain atrophy
magnetic resonance imaging
Authors
Emilia Frankowska
Rafał Kidziński
Grzegorz Zieliński
References (33)- Buliman A, Tataranu LG, Paun DL, et al. Cushing's disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. J Med Life. 2016; 9(1): 12–18.
- Hansson AC, Cintra A, Belluardo N, et al. Gluco- and mineralocorticoid receptor-mediated regulation of neurotrophic factor gene expression in the dorsal hippocampus and the neocortex of the rat. Eur J Neurosci. 2000; 12(8): 2918–2934.
- Hansson AC, Sommer WH, Metsis M, et al. Corticosterone actions on the hippocampal brain-derived neurotrophic factor expression are mediated by exon IV promoter. J Neuroendocrinol. 2006; 18(2): 104–114.
- Tatomir A, Micu C, Crivii C. The impact of stress and glucocorticoids on memory. Clujul Med. 2014; 87(1): 3–6.
- Jeanneteau F, Garabedian MJ, Chao MV. Activation of Trk neurotrophin receptors by glucocorticoids provides a neuroprotective effect. Proc Natl Acad Sci U S A. 2008; 105(12): 4862–4867.
- Jeanneteau FD, Lambert WM, Ismaili N, et al. BDNF and glucocorticoids regulate corticotrophin-releasing hormone (CRH) homeostasis in the hypothalamus. Proc Natl Acad Sci U S A. 2012; 109(4): 1305–1310.
- Conner J, Lauterborn J, Yan Q, et al. Distribution of Brain-Derived Neurotrophic Factor (BDNF) Protein and mRNA in the Normal Adult Rat CNS: Evidence for Anterograde Axonal Transport. J Neurosci. 1997; 17(7): 2295–2313.
- Bremner JD, Randall P, Scott TM, et al. MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. Am J Psychiatry. 1995; 152(7): 973–981.
- Sheline YI, Wang PW, Gado MH, et al. Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A. 1996; 93(9): 3908–3913.
- Lupien SJ, de Leon M, de Santi S, et al. Cortisol levels during human aging predict hippocampal atrophy and memory deficits. Nat Neurosci. 1998; 1(1): 69–73.
- Brown EM, Pierce ME, Clark DC, et al. Test-retest reliability of FreeSurfer automated hippocampal subfield segmentation within and across scanners. Neuroimage. 2020; 210: 116563.
- Han X, Jovicich J, Salat D, et al. Reliability of MRI-derived measurements of human cerebral cortical thickness: the effects of field strength, scanner upgrade and manufacturer. Neuroimage. 2006; 32(1): 180–194.
- Reuter M, Schmansky NJ, Rosas HD, et al. Within-subject template estimation for unbiased longitudinal image analysis. Neuroimage. 2012; 61(4): 1402–1418.
- Sánchez-Benavides G, Gómez-Ansón B, Sainz A, et al. Manual validation of FreeSurfer's automated hippocampal segmentation in normal aging, mild cognitive impairment, and Alzheimer Disease subjects. Psychiatry Res. 2010; 181(3): 219–225.
- Brown ES, J Woolston D, Frol A, et al. Hippocampal volume, spectroscopy, cognition, and mood in patients receiving corticosteroid therapy. Biol Psychiatry. 2004; 55(5): 538–545.
- Bremner JD, Narayan M, Anderson ER, et al. Hippocampal volume reduction in major depression. Am J Psychiatry. 2000; 157(1): 115–118.
- Mervaala E, Föhr J, Könönen M, et al. Quantitative MRI of the hippocampus and amygdala in severe depression. Psychol Med. 2000; 30(1): 117–125.
- Burkhardt T, Lüdecke D, Spies L, et al. Hippocampal and cerebellar atrophy in patients with Cushing's disease. Neurosurg Focus. 2015; 39(5): E5.
- Resmini E, Santos A, Gómez-Anson B, et al. Verbal and visual memory performance and hippocampal volumes, measured by 3-Tesla magnetic resonance imaging, in patients with Cushing's syndrome. J Clin Endocrinol Metab. 2012; 97(2): 663–671.
- Frimodt-Møller KE, Møllegaard Jepsen JR, Feldt-Rasmussen U, et al. Hippocampal Volume, Cognitive Functions, Depression, Anxiety, and Quality of Life in Patients With Cushing Syndrome. J Clin Endocrinol Metab. 2019; 104(10): 4563–4577.
- Starkman MN, Gebarski SS, Berent S, et al. Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing's syndrome. Biol Psychiatry. 1992; 32(9): 756–765.
- Starkman MN, Giordani B, Gebarski SS, et al. Decrease in cortisol reverses human hippocampal atrophy following treatment of Cushing's disease. Biol Psychiatry. 1999; 46(12): 1595–1602.
- Resmini E, Santos A, Gómez-Anson B, et al. Hippocampal dysfunction in cured Cushing's syndrome patients, detected by (1) H-MR-spectroscopy. Clin Endocrinol (Oxf). 2013; 79(5): 700–707.
- Fraser MA, Shaw ME, Cherbuin N. A systematic review and meta-analysis of longitudinal hippocampal atrophy in healthy human ageing. Neuroimage. 2015; 112: 364–374.
- Simmons N, Do H, Lipper M, et al. Cerebral atrophy in Cushing’s disease. Surg Neurol. 2000; 53(1): 72–76.
- Bourdeau I, Bard C, Noël B, et al. Loss of brain volume in endogenous Cushing's syndrome and its reversibility after correction of hypercortisolism. J Clin Endocrinol Metab. 2002; 87(5): 1949–1954.
- Merke DP, Giedd JN, Keil MF, et al. Children experience cognitive decline despite reversal of brain atrophy one year after resolution of Cushing syndrome. J Clin Endocrinol Metab. 2005; 90(5): 2531–2536.
- Andela CD, van Haalen FM, Ragnarsson O, et al. MECHANISMS IN ENDOCRINOLOGY: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies. Eur J Endocrinol. 2015; 173(1): R1–14.
- Gnjidić Z, Sajko T, Kudelić N, et al. Reversible "brain atrophy" in patients with Cushing's disease. Coll Antropol. 2008; 32(4): 1165–1170.
- Bentson J, Reza M, Winter J, et al. Steroids and apparent cerebral atrophy on computed tomography scans. J Comput Assist Tomogr. 1978; 2(1): 16–23.
- Chapman C, Tubridy N, Cook MJ, et al. Short-term effects of methylprednisolone on cerebral volume in multiple sclerosis relapses. J Clin Neurosci. 2006; 13(6): 636–638.
- Santos A, Resmini E, Crespo I, et al. Small cerebellar cortex volume in patients with active Cushing's syndrome. Eur J Endocrinol. 2014; 171(4): 461–469.
- Andela CD, van der Werff SJA, Pannekoek JN, et al. Smaller grey matter volumes in the anterior cingulate cortex and greater cerebellar volumes in patients with long-term remission of Cushing's disease: a case-control study. Eur J Endocrinol. 2013; 169(6): 811–819.
