The Research Of The Whole Brain Morphology And Cognitive Function In Patients With Cushing’s Disease

Part 1 The analysis about white matter hyperintensities in patients with pituitary ACTH adenoma and prolactinomaObjective:To observe and analysis the features about white matter hyperintensities (WMH) in patients with pituitary ACTH adenoma and prolactinoma. To explore the difference between WMH in various pituitary adenomas.Methods:To retrospectively analyze 54 treatment naive patients with pituitary ACTH adenoma and 54 treatment naive patients with prolactinoma in Peking Union Medical College Hospital from March 2015 to March 2016. Referring to Scheltens rating scale, WMH was evaluated in all subjects. The similarities and differences of WMH between these two groups had also been compared.Results:Compared with prolactinoma patients, pituitary ACTH adenoma patients demonstrated higher scores in total scores, frontal lobe, parietal lobe, temporal lobe, deep white matter and periventricular white matter (P<0.05).Conclusions:Compare with prolactinoma patients, WMH was more likely appeared in patients with pituitary ACTH adenoma.Part 2 The correlation research between white matter hyperintensities and cognitive functions in patients with Cushing’s diseaseObjective:To observe and analyze the distributions about white matter hyperintensities (WMH) and the features about cognitive changes in patients with Cushing’s disease (CD). To explore the relationship between WMH and cognitive decline in patients with CD.Methods:Twenty cases of pathological diagnosis for CD were consecutively enrolled and 20 gender and age matched healthy controls were included. All the subjects were evaluated by the Montreal cognitive assessment (MoCA) scale. According to the scores of MoCA (normal scores^26), research was divided into cognitive dysfunction group and normal cognitive group. Scheltens scale was used to evaluate the subjects’ white matter high signals. To separately compare the differences about WMH between CD group, CD cognitive impairment group, CD normal cognitive group and control group and between CD cognitive impairment group and CD normal cognitive group, and compare the differences about cognitive functions between CD group and controls.Results:Compared with controls, CD patients demonstrated higher Scheltens scores (P<0.05), especially in frontal lobe, parietal lobe, deep white matter and periventricular white matter. CD patients with cognitive impairment showed no differences in Scheltens scores (P>0.05), but higher scores in frontal lobe (P<0.05). CD patients with normal cognitive function displayed higher scores in Scheltens scores (P<0.05), especially in parietal lobe and deep white matter. However, in regard to WMH there was no difference in Scheltens scores, frontal lobe, parietal lobe, occipital lobe, temporal lobe, deep white matter, periventricular, basal ganglia and infratentorial among CD patients whether cognitive impairment or not (P>0.05). CD patients manifested significant decline in cognitive function compared with controls (P<0.05), especially in MoCA scores, visuospatial and executive function and language.Conclusions:WMH and cognitive deficits appeared in CD patients and WMH reflected the influence on cognitive function. However, the relationship between WMH and cognitive function remained to be further researched.Part 3 A Voxel-based Morphometry Study of Brain Volume Changes in Patients with Cushing’s diseaseObjective:To compare the differences of grey matter volume (GMV) and white matter volume (WMV) changes between patients with Cushing’s disease (CD) and healthy controls using a voxel-based morphometry (VBM) method. To explore the correlations between abnormal brain volume regions and Scheltens scores, Montreal cognitive assessment (MoCA) scores, and disease durations.Methods:Twenty one cases with pathological diagnosis of CD were consecutively enrolled and 19 healthy controls were included. To analyze the differences of GMV and WMV between the two groups using the VBM method of statistical parametric mapping (SPM) 12 software based on the whole brain three-dimensional structural images, and statistical maps were thresholded with P value 0.05 (family-wise error, FWE corrected). The correlations between volume of abnormal brain regions and Scheltens scores, MoCA scores and disease durations were analyzed by Spearman rank correlation test.Results:Compared with controls, CD patients demonstrated decrease in GMV involved supratentorial multiple regions, especially in bilateral frontal lobe, temporal lobe and limbic lobe (P<0.05, FWE corrected), but not involved hippocampus and cerebellum (P>0.05, FWE corrected). There were no significant differences in WMV between the two groups (P>0.05, FWE corrected). No significant correlations were found between volume of grey matter atrophy regions and Scheltens scores, MoCA scores (P>0.05). The disease duration displayed positive correlation with volume of grey matter atrophy regions in left temporal lobe, superior temporal gyrus and middle temporal gyrus (P<0.05).Conclusions:Decrease of supratentorial multiple regions in GMV were discovered in patients with CD. The disease duration showed positive correlation with volume of grey matter atrophy regions in left temporal lobe. VBM could sensitively reflect GMV changes and detect progress of focal GMV along with the course of the disease.