Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome

Eur J Endocrinol. 2015 Dec;173(6):765-75. doi: 10.1530/EJE-15-0600.

Abstract

Objective: Cushing's syndrome (CS) is associated with high cardiovascular risk. White matter lesions (WML) are common on brain magnetic resonance imaging (MRI) in patients with increased cardiovascular risk.

Aim: To investigate the relationship between cardiovascular risk, WML, neuropsychological performance and brain volume in CS.

Design/methods: Thirty-eight patients with CS (23 in remission, 15 active) and 38 controls sex-, age- and education-level matched underwent a neuropsychological and clinical evaluation, blood and urine tests and 3Tesla brain MRI. WML were analysed with the Scheltens scale. Ten-year cardiovascular risk (10CVR) and vascular age (VA) were calculated according to an algorithm based on the Framingham heart study.

Results: Patients in remission had a higher degree of WML than controls and active patients (P<0.001 and P=0.008 respectively), which did not correlate with cognitive performance in any group. WML severity positively correlated with diastolic blood pressure (r=0.659, P=0.001) and duration of hypertension (r=0.478, P=0.021) in patients in remission. Both patient groups (active and in remission) had higher 10CVR (P=0.030, P=0.041) and VA than controls (P=0.013, P=0.039). Neither the 10CVR nor the VA correlated with WML, although both negatively correlated with cognitive function and brain volume in patients in remission (P<0.05). Total brain volume and grey matter volume in both CS patient groups were reduced compared to controls (total volume: active P=0.006, in remission P=0.012; grey matter: active P=0.001, in remission P=0.003), with no differences in white matter volume between groups.

Conclusions: Patients in remission of Cushing's syndrome (but not active patients) have more severe white matter lesions than controls, positively correlated with diastolic pressure and duration of hypertension. Ten-year cardiovascular risk and vascular age appear to be negatively correlated with the cognitive function and brain volume in patients in remission of Cushing's syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ACTH-Secreting Pituitary Adenoma / surgery*
  • Adenoma / surgery*
  • Adult
  • Blood Pressure
  • Brain / pathology*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / metabolism*
  • Cardiovascular Diseases / physiopathology
  • Case-Control Studies
  • Cholesterol, HDL / blood
  • Cognition
  • Cognition Disorders / pathology*
  • Cognition Disorders / psychology
  • Cushing Syndrome / pathology*
  • Cushing Syndrome / psychology
  • Cushing Syndrome / surgery
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Organ Size
  • Remission Induction
  • Risk Factors
  • Smoking / epidemiology
  • White Matter / pathology*

Substances

  • Cholesterol, HDL