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Updated: Aug 17, 2025
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Published on: April 23, 2021
Presence of cerebral microbleeds is associated with cognitive decline in acromegaly
Zhengxing Xie1,2,3, Yan Zhuang1,2, Zongqiang Zhang4
1Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China.
Background:
Cognitive decline in acromegaly has gained increasing attention. Cerebral microbleeds (CMBs) as radiographic markers for microvascular injury have been linked to various types of cognitive decline. However, the association between CMB formation and acromegaly has not yet been quantified. This study is designed to investigate the prevalence and the radiographic patterns of CMBs and the association between cognitive function and acromegaly-related CMBs in growth hormone (GH)-secreting pituitary adenoma, which is characterized by acromegaly.
Methods:
In a cohort of 55 patients with GH-secreting pituitary adenoma (acromegaly) and 70 healthy control (HC) patients, we determined the presence of CMBs using a 3.0-T MRI scanner. The numbers, locations, and grades of CMBs were determined via susceptibility-weighted imaging (SWI) and the Microbleed Anatomical Rating Scale. Obstructive sleep apnea (OSA) was assessed using the criteria of the American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.2. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance within 3 days of admission. The association between CMBs and cognitive function as well as clinical characteristics was explored.
Results:
The incidence of CMBs was 29.1%, whereas that of OSA was 65.5% in acromegaly. There was a statistically significant difference in the prevalence of CMBs between subjects with and without acromegaly (29.1% and 5.3%, respectively) (p < 0.01). The age of acromegaly patients with CMBs was much younger compared with HCs with CMBs. Compared with HCs, a significant cognitive decline and the occurrence of OSA were demonstrated in patients with acromegaly (p < 0.01). Binary logistic regression analysis adjusted for age, education, and body mass index (BMI) revealed that CMB was an independent risk factor for cognitive impairment in patients with acromegaly (OR = 3.19, 95% CI 1.51-6.76, p = 0.002). Furthermore, in the logistic regression models adjusted for age, BMI, diabetes, and hypertension, OSA was independently associated with the occurrence of CMBs in patients with acromegaly (OR = 13.34, 95% CI 3.09-57.51, p = 0.001).
Conclusions:
A significant increase of CMBs was demonstrated in patients with acromegaly, which may be a result of OSA in acromegaly. The present study indicated that increasing CMBs are responsible for cognitive decline in patients with acromegaly.
Insights
Cerebral microbleeds (CMBs) are more common in acromegaly patients and independently predict cognitive decline. Obstructive sleep apnea (OSA) is linked to CMBs in acromegaly, suggesting a potential pathway for microvascular injury and cognitive impairment.
Area of Science:
- Neuroimaging
- Endocrinology
- Neurology
Background:
- Acromegaly, caused by growth hormone (GH)-secreting pituitary adenoma, is increasingly associated with cognitive decline.
- Cerebral microbleeds (CMBs) are radiographic markers of microvascular injury linked to cognitive impairment.
- The relationship between CMBs and acromegaly requires quantification.
Purpose of the Study:
- To investigate the prevalence and radiographic patterns of CMBs in acromegaly patients.
- To explore the association between cognitive function and acromegaly-related CMBs.
- To examine the role of obstructive sleep apnea (OSA) in CMB formation in acromegaly.
Main Methods:
- A cohort study comparing 55 acromegaly patients with 70 healthy controls (HCs).
- Cerebral microbleeds (CMBs) detected using 3.0-T MRI with susceptibility-weighted imaging (SWI).
- Cognitive function assessed using the Montreal Cognitive Assessment (MoCA); OSA assessed using American Academy of Sleep Medicine (AASM) criteria.
Main Results:
- CMB incidence was 29.1% in acromegaly patients versus 5.3% in HCs (p < 0.01).
- Acromegaly patients showed significant cognitive decline and higher OSA prevalence (65.5%) compared to HCs (p < 0.01).
- CMBs were an independent risk factor for cognitive impairment in acromegaly (OR = 3.19, p = 0.002); OSA was independently associated with CMBs (OR = 13.34, p = 0.001).
Conclusions:
- Acromegaly is associated with a significantly increased prevalence of CMBs, potentially mediated by OSA.
- CMBs are an independent predictor of cognitive decline in acromegaly patients.
- These findings highlight the importance of microvascular injury and OSA in the cognitive impairment associated with acromegaly.
