Abstract
Background: Decreased hippocampal volume is observed in patients with Cushing’s syndrome
and other conditions associated with elevated cortisol levels, stress, or both. Reversibility
of hippocampal neuronal atrophy resulting from stress occurs in animals. Our study
investigated the potential for reversibility of human hippocampal atrophy.
Methods: The study included 22 patients with Cushing’s disease. Magnetic resonance
brain imaging was performed prior to transsphenoidal microadenomectomy and again after
treatment.
Results: Following treatment, hippocampal formation volume (HFV) increased by up to
10%. The mean percent change (3.2 ± 2.5) was significantly greater (p < .04) than that of the comparison structure, caudate head volume (1.5 ± 3.4). Increase
in HFV was significantly associated with magnitude of decrease in urinary free cortisol
(r = −.61, p < .01). This relationship strengthened after adjustments for age, duration of disease,
and months elapsed since surgery (r = −.70, p < .001). There was no significant correlation between caudate head volume change
and magnitude of cortisol decrease.
Conclusions: Changes in human HFV associated with sustained hypercortisolemia are
reversible, at least in part, once cortisol levels decrease. While many brain regions
are likely affected by hypercortisolemia, the human hippocampus exhibits increased
sensitivity to cortisol, affecting both volume loss and recovery.
Keywords
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Article info
Publication history
Accepted:
July 19,
1999
Received in revised form:
July 14,
1999
Received:
January 29,
1999
Identification
Copyright
© 1999 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
