Elsevier

Surgical Neurology

Volume 53, Issue 1, January 2000, Pages 72-76
Surgical Neurology

Neoplasm
Cerebral atrophy in Cushing’s disease

https://doi.org/10.1016/S0090-3019(99)00197-4Get rights and content

Abstract

BACKGROUND

Cushing’s disease causes significant pathological changes throughout the body as a result of elevated cortisol levels. Very few systematic investigations have focused on the morphologic effects of hypercortisolism on the central nervous system. The validity of using premature cerebral atrophy as a diagnostic tool for Cushing’s disease remains unknown.

METHODS

This study includes 63 patients with Cushing’s disease who were evaluated and treated at the University of Virginia Medical Center. Radiologists randomly compared these individuals with age- and sex-matched controls in a blinded protocol, assessing the degree of cerebral atrophy on computed tomography and magnetic resonance scans.

RESULTS

Patients with Cushing’s disease showed significant premature atrophy when compared with controls. This trend continued after subdividing the groups based on age and duration of symptoms except in the following groups: age greater than 60, duration of symptoms less than 1 year, and symptoms lasting between 4–5 years.

CONCLUSIONS

Excluding the three aforementioned groups, the hypercortisolemic state manifested in patients with Cushing’s disease promotes the premature development of cerebral atrophy, which can be identified on routine radiologic imaging and may assist in the clinical diagnosis of the condition.

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Materials and methods

Sixty-three patients (15 men, 48 women) were retrospectively analyzed in the study, having undergone evaluation and treatment for Cushing’s disease at the University of Virginia Medical Center between July 1992 and December 1995. All patients were operated on by the senior author (ERL) and proven to have adrenocorticotropin hormone (ACTH)-secreting tumors on pathological analyses. Cerebral imaging studies (CT and MRI) obtained during the patient’s treatment period were reviewed. Additionally,

Results

Primary analysis assessed the difference in the grading of atrophy between CT and MRI scans. A total of 53 scans were evaluated in which both forms of imaging were available. The average degree of atrophy for all patients with Cushing’s disease was 1.0 (SD = 1.0) when using CT grading and 1.1 (SD = 0.7) when using MRI. No difference was identified between the two imaging techniques (p = 0.135).

Comparison of patients with Cushing’s disease (mean, 1.1) and controls (mean, 0.44) revealed a

Discussion

The systemic effects of the hypercortisolemic state manifested in Cushing’s disease are well known 1, 7. The elevated cortisol levels cause catabolic changes which are typically demonstrated by atrophic changes in bone and soft tissues. Such changes include osteoporosis, muscle atrophy, easy bruising, and cutaneous striae. Emotional and cognitive changes are also well correlated with excess steroid administration 1, 5, 7.

With regard to effects on the central nervous system, Bentson described an

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