Abstract
Brain structural abnormalities are often observed on magnetic resonance imaging (MRI) scans of Cushing's syndrome patients, but the pathogenesis is not fully understood. To understand the relationship between brain structural abnormalities and potential risk factors in active Cushing's disease (CD) patients, a total of 101 treatment-naïve CD patients and 95 sex-, age- and education matched controls with non-functioning adenomas (NFA) underwent clinical evaluation and MRI investigation, and the relative risk factors were analyzed. 14 patients in sustained remission after transsphenoidal surgery were followed. Compared with the NFA subjects, the patients with CD had more cortical (P < 0.01) and subcortical atrophy (P < 0.01) and a higher prevalence of white matter hyperintensity (WMH) (P < 0.01). WMH severity in CD patients positively correlated with age (r = 0.532, P = 0.000), disease course (r = 0.257, P = 0.009), postprandial glucose (r = 0.278, P = 0.005), frequency of left ventricular hypertrophy (r = 0.398, P = 0.001) and hypothyroidism (r = 0.246, P = 0.014). The markers of cortical and subcortical atrophy (sylvian fissure ratio, bifrontal ratio, bicaudate ratio and third ventricle width) were positively associated with the progression of WMH in the CD patients. In the follow-up of 14 patients with CD, brain atrophy and WMH was partially reversible after correction of hypercortisolism. In conclusions, brain atrophy and WMH were more likely to appear in CD patients and were possibly partially reversible following correction of hypercortisolism.
Highlights
Had been in remission of hypercortisolism for at least one year after surgery
The ultrasonic cardiogram examinations showed that 55 Cushing’s disease (CD) patients had left ventricular hypertrophy (LVH)
Of the 101 CD participants (11% with macroadenomas and 89% with microadenomas), 67.5% had received lipid-lowering drugs, 45.5% and 15.8% were diagnosed with diabetes and prediabetes, respectively, 77.2% were diagnosed with hypertension, and 39.6% were diagnosed with hypokalemia
Summary
One hundred and one consecutive patients who had undergone evaluation and treatment for Cushing’s disease (CD) at West China Hospital between 2013 and 2019 were involved in this study. The study was approved by the Ethics Committee of West China Hospital and conformed to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all subjects in our study. All 101 CD patients were diagnosed based on agreed g uidelines[41], with clinical manifestations and positive biochemical tests. The mean age of the patients at the time of diagnosis was 37.4 ± 12.6 years. Ninety-five sex-, age- and education matched treatment-naïve subjects diagnosed with nonsecreting pituitary microadenoma (NFA) were recruited in West China hospital as controls
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