Subtle Cognitive Impairments in Patients with Long-Term Cure of Cushing’s Disease.

Tiemensma, J; Kokshoorn, NE; Biermasz, NR; Keijser, BSA; Wassenaar, MJE; Middelkoop, H.A.M.; Pereira, Alberto M.; Romijn, J A

doi:10.1210/endo-meetings.2010.part1.p6.p1-275

Cited by 24 publications

(52 citation statements)

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“…This is supported by recent clinical evidence showing that patients with Cushing's syndrome and in long-term remission following pituitary surgery exhibit global cognitive and attention deficits [50,51]. In a cross-sectional study by Tiemensma et al impairments in cognitive function were found in patients with Cushing's disease in remission compared with healthy individuals and patients with NFPA [50]. The authors concluded that the effects on the central nervous system are irreversible and most likely explained by previous glucocorticoid excess [50].…”

Section: Cognitive Impairmentsupporting

confidence: 56%

“…In a cross-sectional study by Tiemensma et al impairments in cognitive function were found in patients with Cushing's disease in remission compared with healthy individuals and patients with NFPA [50]. The authors concluded that the effects on the central nervous system are irreversible and most likely explained by previous glucocorticoid excess [50]. The findings of Ragnarsson et al are consistent with this conclusion.…”

Section: Cognitive Impairmentmentioning

confidence: 81%

“…In addition, observations suggest that chronic hypercortisolism may have irreversible effects on the central nervous system, potentially resulting in permanent damage to intellectual function [48,49]. This is supported by recent clinical evidence showing that patients with Cushing's syndrome and in long-term remission following pituitary surgery exhibit global cognitive and attention deficits [50,51]. In a cross-sectional study by Tiemensma et al impairments in cognitive function were found in patients with Cushing's disease in remission compared with healthy individuals and patients with NFPA [50].…”

Section: Cognitive Impairmentmentioning

confidence: 86%

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Cushing’s disease: the burden of illness

et al. 2016

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Cushing's syndrome is caused by prolonged exposure to elevated cortisol levels. The most common form of endogenous Cushing's syndrome is Cushing's disease, which results from an adrenocorticotropic hormone-secreting pituitary tumour. Cushing's disease is associated with increased mortality, mostly attributable to cardiovascular complications, and a host of comorbidities such as metabolic and skeletal disorders, infections and neuropsychiatric disturbances. As a consequence, Cushing's disease substantially impairs health-related quality of life. It is crucial that the condition is diagnosed as early as possible, and that rapid and effective treatment is initiated in order to limit long-term morbidity and mortality. The initial treatment of choice for Cushing's disease is selective transsphenoidal pituitary surgery; however, the risk of recurrence after initial surgery is high and remains so for many decades after surgery. A particular concern is the growing body of evidence indicating that the negative physical and psychosocial sequelae of chronic hypercortisolism may persist in patients with Cushing's disease even after long-term surgical 'cure'. Current treatment options for post-surgical patients with persistent or recurrent Cushing's disease include second surgery, radiotherapy, bilateral adrenalectomy and medical therapy; however, each approach has its limitations and there is an unmet need for more efficacious treatments. The current review provides an overview of the burden of illness of Cushing's disease, underscoring the need for prompt diagnosis and effective treatment, as well as highlighting the need for better therapies.

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Section: Cognitive Impairmentsupporting

confidence: 56%

Section: Cognitive Impairmentmentioning

confidence: 81%

Section: Cognitive Impairmentmentioning

confidence: 86%

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Cushing’s disease: the burden of illness

et al. 2016

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“…This is an interesting difference that might be due to more severe long-term effects of Cushing's disease compared with NFMA. Patients after long-term remission of Cushing's disease suffer from subtle cognitive impairments, increased prevalence of psychopathology, and an increased incidence of maladaptive personality traits (7,15). These impairments could be invalidating in everyday life, which in turn could lead to a higher need for social support.…”

Section: Discussionmentioning

confidence: 99%

“…A four-point scale was used, ranging from seldom or never to very often. The statements lead to seven subscales: active coping (score ranging from 7-28), seeking distraction (score ranging from 8 -32), avoiding (score ranging from 8 -32), seeking social support (score ranging from 6 -24), passive coping (score ranging from 7-28), expressing emotions (score ranging from 3-12), and fostering reassuring thoughts (score ranging from [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Utrecht Coping List (Ucl)mentioning

confidence: 99%

Coping Strategies in Patients after Treatment for Functioning or Nonfunctioning Pituitary Adenomas

Tiemensma

Kaptein

Pereira

et al. 2011

The Journal of Clinical Endocrinology & Metabolism

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Prolonged corticosterone exposure induces dendritic spine remodeling and attrition in the rat medial prefrontal cortex

Anderson

Glanz

Johnson

et al. 2016

J of Comparative Neurology

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The stress-responsive hypothalamo-pituitary-adrenal (HPA) axis plays a central role in promoting adaptations acutely, while adverse effects on physiology and behavior following chronic challenges may result from over-activity of this system. Elevations in glucocorticoids, the end-products of HPA activation, play roles in adaptive and maladaptive processes by targeting cognate receptors throughout neurons in limbic cortical networks to alter synaptic functioning. Since previous work has shown that chronic stress leads to functionally relevant regressive alterations in dendritic spine shape and number in pyramidal neurons in medial prefrontal cortex (mPFC), here we examine the capacity of sustained increases in circulating corticosterone alone to alter dendritic spine morphology and density in this region. Rats were implanted with subcutaneous corticosterone pellets to provide continuous exposure to levels approximating the circadian mean or peak of the steroid for 1, 2, or 3 weeks. Pyramidal neurons in prelimbic area of mPFC were selected for intracellular fluorescent dye-filling, followed by high-resolution 3D imaging and analysis of dendritic arborization and spine morphometry. Two or more weeks of corticosterone exposure decreased dendritic spine volume in mPFC, whereas higher dose exposure of the steroid resulted in apical dendritic retraction and spine loss in the same cell population, with thin spine subtypes showing the greatest degree of attrition. Finally, these structural alterations were noted to persist following a 3-week washout period and corresponding restoration of circadian HPA rhythmicity. These studies suggest that prolonged disruptions in adrenocortical functioning may be sufficient to induce enduring regressive structural and functional alterations in mPFC.

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Subtle Cognitive Impairments in Patients with Long-Term Cure of Cushing’s Disease.

Cited by 24 publications

References 0 publications

Cushing’s disease: the burden of illness

Cushing’s disease: the burden of illness

Coping Strategies in Patients after Treatment for Functioning or Nonfunctioning Pituitary Adenomas

Prolonged corticosterone exposure induces dendritic spine remodeling and attrition in the rat medial prefrontal cortex

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