Endocrine Abstracts

Objective: Cushing’s disease (CD) may cause atrophy of different regions of the human brain, mostly affecting the hippocampus and the cerebellum. This study evaluates the use of 3-T MRI of newly diagnosed patients with CD to detect atrophic degeneration with voxel-based volumetry.

Methods: Subjects with newly diagnosed, untreated CD were included and underwent 3-T MRI. Images were analyzed using a voxelwise statistical test to detect reduction of brain parenchyma. In addition, an atlas-based volumetric study for regions likely to be affected by CD was performed.

Results: Nineteen patients with a mean disease duration of 24 months were included. Tumor markers included adre-nocorticotropic hormone (median 17.5 pmol/l), cortisol (949.4 nmol/l), and dehydroepiandrosterone sulfate (5.4 μmol/l). The following values are expressed as the mean±S.D. The voxelwise statistical test revealed clusters of significantly reduced gray matter in the hippocampus and cerebellum, with volumes of 2.90±0.26 ml (right hippocampus), 2.89±0.28 ml (left hippocampus), 41.95±4.67 ml (right cerebellar hemisphere), and 42.11±4.59 ml (left cerebellar hemisphere). Healthy control volunteers showed volumes of 3.22±0.25 ml for the right hippocampus, 3.23±0.25 ml for the left hippocampus, 50.87±4.23 ml for the right cerebellar hemisphere, and 50.42±3.97 ml for the left cerebellar hemisphere.

Conclusion: Patients with untreated CD show significant reduction of gray matter in the cerebellum and hippocampus. These changes can be analyzed and objectified with the quantitative voxel-based method described in this study.