Smaller grey matter volumes of the anterior cingulate cortex (ACC) and greater cerebellar volumes in patients despite long-term remission of Cushing's disease: a case control study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 26-40-Glucocorticoid Actions & Disease
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-32
Cornelie D. Andela*1, Steven J.A. van der Werff1, J. Nienke Pannekoek1, Susan M. van den Berg1, Onno C. Meijer1, Mark A. Buchem1, Serge A.R.B. Rombouts1, Roos C. van der Mast1, Johannes A. Romijn2, Jitske Tiemensma3, Nienke R. Biermasz1, Nic J.A. van der Wee1 and Alberto M. Pereira1
1Leiden University Medical Center, The Netherlands, 2Academic Medical Center, Amsterdam, Netherlands, 3University of California Merced, Merced, CA
Context: Patients in long-term remission of Cushing’s disease (CD) have persistent impairments in psychological and cognitive functioning. It is unknown whether, and to what extent, these impairments are also accompanied by structural abnormalities in the brain.

Objective: To investigate structural changes in the brain of patients after long-term remission of CD.

Design: A cross-sectional study.

Patients and Methods: In 25 patients in long-term remission of CD and 25 matched healthy controls, grey matter volume of the regions of interest (hippocampus, amygdala, anterior cingulate cortex) and the whole brain were examined, using 3T Magnetic Resonance Imaging and a voxel based morphometry (VBM) approach. In addition, we assessed psychological and cognitive functioning using validated questionnaires, and clinical severity using the Cushing's syndrome Severity Index.

Results: Compared to controls, patients had significantly smaller grey matter volumes of areas in the anterior cingulate cortex (on average 14%, P<0.05) and significantly greater volumes in the left posterior lobe of the cerebellum (on average 34%, P<0.05). There were no significant differences in grey matter volumes in the hippocampus and amygdala. As expected CD patients demonstrated more depressive symptoms (P=0.005), more anxiety (P=0.003) and more apathy (P=0.002) compared to controls, but the differences in grey matter volumes were not associated with clinical severity, nor with measures of psychological or cognitive dysfunction.

Conclusion: Patients in long-term remission of CD showed structural abnormalities in the brain, with smaller ACC volumes and an asymmetric enlargement of the posterior lobe of the cerebellum, in the presence of increased depressive symptoms, anxiety, and apathetic behavior. This indicates incomplete recovery of the central nervous system despite successful treatment for CD.


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