Structural and functional brain alterations in Cushing's disease: A narrative review

Area of Science:

• Neuroendocrinology
• Neuroimaging
• Neuropsychiatry

Background:

• Cushing's disease (CD) is associated with notable neurocognitive and psychiatric symptoms.
• These symptoms correlate with structural and functional brain changes.

Purpose of the Study:

• To review multimodal neuroimaging and neurophysiological studies on brain alterations in Cushing's disease.
• To elucidate the impact of hypercortisolemia on brain structure and function.

Main Methods:

• Review of structural neuroimaging studies (e.g., MRI) assessing gray matter, white matter integrity, and demyelination.
• Analysis of functional neuroimaging studies (e.g., fMRI) examining brain connectome networks.
• Inclusion of neurophysiological data where available.

Main Results:

• Structural studies reveal gray matter atrophy, reduced white matter integrity, and demyelination in various brain regions.
• Functional imaging identifies altered activity in the limbic, default mode, and executive control networks due to hypercortisolemia.
• Post-remission, gray matter atrophy and network dysfunction show partial reversibility, but white matter integrity deficits persist for years.

Conclusions:

• Cushing's disease patients exhibit significant structural and functional brain connectomic alterations.
• These brain changes offer insights into the observed neurocognitive and psychiatric disturbances.
• Long-term white matter integrity issues highlight the chronic impact of the disease.