Quantitative brain MRI in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones

Webb, Emma A., Elliott, Lucy, Carlin, Dominic, Wilson, Martin, Hall, Kirsty, Netherton, Jennifer, Reed, Julie, Barrett, Tim G., Salwani, Vijay, Clayden, Jon D., Arlt, Wiebke, Krone, Nils, Peet, Andrew C. and Wood, Amanda G. 2018, Quantitative brain MRI in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones, Journal of clinical endocrinology and metabolism, vol. 103, no. 4, pp. 1330-1341, doi: 10.1210/jc.2017-01481.

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Title Quantitative brain MRI in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones
Author(s) Webb, Emma A.
Elliott, Lucy
Carlin, Dominic
Wilson, Martin
Hall, Kirsty
Netherton, Jennifer
Reed, Julie
Barrett, Tim G.
Salwani, Vijay
Clayden, Jon D.
Arlt, Wiebke
Krone, Nils
Peet, Andrew C.
Wood, Amanda G.ORCID iD for Wood, Amanda G. orcid.org/0000-0002-1537-6858
Journal name Journal of clinical endocrinology and metabolism
Volume number 103
Issue number 4
Start page 1330
End page 1341
Total pages 12
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2018-04
ISSN 0021-972X
1945-7197
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
MAGNETIC-RESONANCE-SPECTROSCOPY
GLUCOCORTICOID MEDICATION
WORKING-MEMORY
DIFFUSION
CORTICOSTEROIDS
CHILDREN
TERM
TESTOSTERONE
PREVALENCE
DISEASE
Summary © 2018 Endocrine Society. Context Brain white matter hyperintensities are seen on routine clinical imaging in 46% of adults with congenital adrenal hyperplasia (CAH). The extent and functional relevance of these abnormalities have not been studied with quantitative magnetic resonance imaging (MRI) analysis. Objective To examine white matter microstructure, neural volumes, and central nervous system (CNS) metabolites in CAH due to 21-hydroxylase deficiency (21OHD) and to determine whether identified abnormalities are associated with cognition, glucocorticoid, and androgen exposure. Design, Setting, and Participants A cross-sectional study at a tertiary hospital including 19 women (18 to 50 years) with 21OHD and 19 age-matched healthy women. Main Outcome Measure Recruits underwent cognitive assessment and brain imaging, including diffusion weighted imaging of white matter, T1-weighted volumetry, and magnetic resonance spectroscopy for neural metabolites. We evaluated white matter microstructure by using tract-based spatial statistics. We compared cognitive scores, neural volumes, and metabolites between groups and relationships between glucocorticoid exposure, MRI, and neurologic outcomes. Results Patients with 21OHD had widespread reductions in white matter structural integrity, reduced volumes of right hippocampus, bilateral thalami, cerebellum, and brainstem, and reduced mesial temporal lobe total choline content. Working memory, processing speed, and digit span and matrix reasoning scores were reduced in patients with 21OHD, despite similar education and intelligence to controls. Patients with 21OHD exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance. Conclusion We demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers are a potential target for treatment.
Language eng
DOI 10.1210/jc.2017-01481
Indigenous content off
Field of Research 1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2017, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30128618

Document type: Journal Article
Collections: Faculty of Health
School of Psychology
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