Impaired attention in patients with adrenal insufficiency – Impact of unphysiological therapy

Blacha, Antje; Rahvar, Amir H; Flitsch, Jörg; Loo, Iris van de; Kropp, Peter; Harbeck, Birgit

doi:10.1016/j.steroids.2020.108788

Cited by 10 publications

(8 citation statements)

References 43 publications

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“…Given the debate on the consequences of brain irradiation, patients after pituitary radiotherapy were excluded ( 9 , 22 ). Hydrocortisone replacement dosage and GH deficiency were also controlled to avoid interference between imperfect hormonal replacement and cognitive performance ( 19 – 21 ). A delay between remission of CD and recovery of cognitive impairments has also been suggested ( 2 , 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, patients may have confounding factors impairing cognition and, more specifically, memory. These include advanced age ( 14 ), obesity, poorly-controlled diabetes ( 15 , 16 ), cerebral vascular disease and poorly controlled hypertension ( 17 ), psychopathology and depression including psychotropic treatments ( 18 ), excessive hydrocortisone replacement, imperfect hormonal replacement for hypothyroidism and untreated GH deficiency ( 19 – 21 ). Among the treatment modalities, pituitary radiotherapy may be associated to cognitive deficits ( 22 , 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remission

et al. 2022

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ContextImpaired cognition and altered quality of life (QoL) may persist despite long-term remission of Cushing’s disease (CD). Persistent comorbidities and treatment modalities may account for cognitive impairments. Therefore, the role of hypercortisolism per se on cognitive sequelae remains debatable.ObjectiveTo investigate whether memory and QoL are impaired after long-term remission of CD in patients with no confounding comorbidity.Design and SettingCross-sectional case-control study in two tertiary referral centersPatients25 patients (44.5 ± 2.4 years) in remission from CD for 102.7 ± 19.3 Mo and 25 well-matched controls, without comorbidity or treatment liable to impair cognition.Main Outcome Measure(s)Hippocampus- and prefrontal cortex-dependent memory, including memory flexibility and working memory, were investigated using multiple tests including sensitive locally-developed computerized tasks. Depression and anxiety were evaluated with the MADRS and HADS questionnaires. QoL was evaluated with the SF-36 and CushingQoL questionnaires. The intensity of CD was assessed using mean urinary free cortisol and a score for clinical symptoms.ResultsCD patients displayed similar performance to controls in all cognitive tests. In contrast, despite the absence of depression and a minimal residual clinical Cushing score, patients had worse QoL. Most of the SF36 subscales and the CushingQoL score were negatively associated only with the duration of exposure to hypercortisolism (p≤ 0.01 to 0.001).ConclusionsPersistent comorbidities can be a primary cause of long-lasting cognitive impairment and should be actively treated. Persistently altered QoL may reflect irreversible effects of hypercortisolism, highlighting the need to reduce its duration.Clinical Trial Registration numberhttps://clinicaltrials.gov, identifier NCT02603653

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remission

et al. 2022

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“…Replacement therapy for primary adrenal insufficiency (PAI) with glucocorticoids (GC) and mineralocorticoids (MC) compensates for the existing hormone deficit and enables most patients to cope with everyday life. On closer examination, however, there is increasing evidence that a substantial number of patients suffer from physical or psychological limitations despite efforts to provide an individually adjusted medication ( 1 , 2 , 3 ). Currently available drugs only allow a rough imitation of physiological hormone secretion.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive assessment of tissue sodium content in patients with primary adrenal insufficiency

Chifu

Weng

Burger-Stritt

et al. 2022

European Journal of Endocrinology

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Objective Replacement therapy in primary adrenal insufficiency (PAI) with corticosteroids modulates sodium homeostasis. Serum sodium is, however, prone to osmotic shifts induced by several additional factors besides corticosteroids and does not always reliably reflect treatment quality. Non-osmotic tissue storage can be visualized by sodium MRI (23Na-MRI) and might better reflect corticosteroid activity. Design Longitudinal study of 8 patients with newly diagnosed PAI and cross-sectional study in 22 patients with chronic PAI is reported here. Comparison was made with matched healthy controls. Methods Using a 23Na-MRI protocol on a 3T scanner, relative sodium signal intensities (rSSI) to signal intensities of the reference vial with 100 mmol/L of sodium were determined in the muscle and skin of the lower calf. Results In newly diagnosed patients, tissue rSSI (median, range) were reduced and significantly increased after treatment initiation reaching levels similar to healthy controls (muscle: from 0.15 (0.08, 0.18) to 0.18 (0.14, 0.27), P = 0.02; skin: from 0.12 (0.09, 0.18) to 0.18 (0.14, 0.28), P < 0.01). Muscle rSSI was significantly higher in patients with chronic PAI compared to controls (0.19 (0.14, 0.27) vs 0.16 (0.12, 0.20), P < 0.01). In chronic PAI, skin rSSI significantly correlated with plasma renin concentration. Conclusion 23Na-MRI provides an additional insight into sodium homeostasis, and thus the quality of replacement therapy in PAI, as tissue sodium significantly changes once therapy is initiated. The increased tissue sodium in patients with chronic PAI might be an indication of over-replacement.

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“…The clinical manifestations of AI include non-specific symptoms, including nausea, fatigue, hypotension, and weight loss. Cortisol deficiency can lead to a life-threatening adrenal crisis in stressful situations [ 1 , 2 ]. Hence the importance of GC replacement therapy (hydrocortisone) in preventing adrenal crisis and giving time to the hypothalamic-pituitary-adrenal axis to recover its normal function.…”

Section: Introductionmentioning

confidence: 99%

Assessing recovery of adrenal function in glucocorticoid-treated patients: Our strategy for screening and management

Draoui

Alla

Derkaoui

et al. 2022

Annals of Medicine &Amp; Surgery

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Impaired attention in patients with adrenal insufficiency – Impact of unphysiological therapy

Cited by 10 publications

References 43 publications

Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remission

Impaired quality of life, but not cognition, is linked to a history of chronic hypercortisolism in patients with Cushing’s disease in remission

Non-invasive assessment of tissue sodium content in patients with primary adrenal insufficiency

Assessing recovery of adrenal function in glucocorticoid-treated patients: Our strategy for screening and management

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