| Objectives1. To observe the psychiatric symptoms and the characteristics of brain task functional. magnetic resonance imaging (Task fMRI) of patients with Cushing's Syndrome (CS).2. To analyze the post-operational alterations of psychiatric symptoms and brain Task fMRI in patients with CS.Methods1. Forty patients recruited from Peoples Liberation Army General Hospital(PLAGH) during September 2015 to March 2017 with confirmed CS (29 ACTH-independent and 11 ACTH-dependent) were compared to 21 healthy control subjects, matched by age, sex and education. The differences of response to psychiatric evaluation and brain Task fMRI between CS group and control subjects, as well as between ACTH-independent and ACTH-dependent patients were evaluated.2. The follow-up of CS patients was carried out to analyze the post-operational psychiatric evaluation and brain Task fMRI alterations.Results1. a) Scores on questionnaires of anxiety, depress and negative emotion were significantly higher in CS patients compared with the healthy control group.Consequently, the control group exhibited higher score in the evaluation of positive emotion (P<0.05). No statistical difference was reported in the scores of anxiety and negative emotion assessment between the ACTH-dependent and ACTH-independent groups (P>0.05). But ACTH-independent patients had significantly better performance in the response to the depression evaluation,positive emotion and CS life quality(P<0.05).b) When watching positive pictures, the activation of bilateral cerebellum, right parahippocampa gyrus, right hippocampus, left middle temporal gyrus and right middle frontal gyrus in CS group decreased. On the other side, in the case of negative pictures,the healthy control group outperformed the CS group in the activation degree of bilateral cerebellum. But CS patients showed higher activation in left middle frontal gyrus and right superior frontal gyrus compared with the controls (P<0.001,AlphaSim corrected).In the positive picture reaction analysis, ACTH-independent CS patients showed weak activation in left superior temporal gyrus compared with ACTH-dependent group,while the activation degree of their bilateral dorsal anterior cingulate cortex,bilateralsuperior frontal gyrus and left middle frontal gyrus was much stronger. In the case of negative picture experiment, ACTH-independent CS patients had greater activation in bilateral cerebellum, left superior frontal gyrus, left middle frontal gyrus,left precuneus and right postcentral gyrus, compared with the control group (P<0.01,AlphaS im corrected).c) When CS patients and healthy control group watch positive pictures, a negative correlation can be witnessed between the activation degree of right cerebellum and 8:00 am cortisol level,the percentage of cortisol change and depression performance. The scores on depression scale were also negatively related to the activation degree of right middle frontal gyrus. In the case of negative pictures, the activation degree of left cerebellumwas negatively correlated both to the level of 0:00 am cortisol and the percentage ofcortisol change. But right cerebellum exhibited similar performance compared with what occurred when patients were shown positive pictures. What's more,a positive correlation was exhibited between the level of cortisol at 8:00 am and the activation degree of bilateral middle frontal gyrus (P<0.05).In the positive picture reaction analysis of ACTH-independent CS patients and ACTH-dependent group, the activation degree of left superior temporal gyrus was negatively correlated to the 16:00 pm cortisol level, and to the 0:00 am and 16:00 pm ACTH level, while the activation degree of right superior frontal gyrus was negatively correlated to the 0:00 am, 8:00 am, 16:00 pm cortisol level, and to the 0:00 am and 16:00 pm ACTH level, as well as ufc level, depression evaluation and negative emotion assessment. In the case of negative picture experiment, negative correlation can be clearly shown between the activation degree of bilateral cerebellum and 0:00 am &16:00 pm ACTH level; between the activation degree of left middle frontal gyrus and 16:00 pm cortisol level, 0:00 am & 16:00 pm ACTH level; between the activation degree of left superior frontal gyrus and 16:00 pm cortisollevel, 0:00 am & 16:00 pm ACTH level and ufc level; and also between the activation degree of left precuneus and 0:00 am, 8:00 pm & 16:00 pm cortisol level and 0:00 am, 16:00 pm ACTH level as well as ufc level (P<0.05).2. Seven post-operational follow-ups were carried out 8±4 months after the treatment. A significant decrease was detected in the level of ufc and 0:00 am, 8:00 am and 16:00 pm cortisol (P<0.05). These patients performed better in the evaluation results of depression, anxiety, negative emotional assessment and life quality questionnaire (P<0.05). The only exception that showed no statistical meaning was the assessment of positive emotion (P>0.05). Post-operational CS patients were not significantly different from the healthy control group in anxiety and negative emotion analysis (P>0.05), but the depression score was higher and the positive emotion score was lower (P<0.05). Compared with the pre-operational situation, when presented with positive pictures, the CS patients had weak activation degree in right cerebellum and bilateral postcentral gyrus after the treatment, while the activation degree was stronger in the areas of bilateral middle occipital gyrus, left middle frontal gyrus and right superior frontal gyrus. And in the study of negative pictures, post-operational CS patients had significant activation increase in the areas of right fusiform gyrus, bilateral middle occipital gyrus, right precuneus, right posterior cingulate cortex, righe superior temporal gyrus, left Inferior parietal lobule and left middle frontal gyrus compared with the control group (P<0.01,AlphaSim corrected). Their activation degree of rightpostcentral gyrus was negatively correlated to the 8:00 amcortisol level, and their right superior frontal gyrus activation degree was also negatively related to the change of CS life quality. The activation degree of right precuneus was positively related to the change of anxiety evaluation (P<0.05).Conclusion1. In the case of most CS patients, depression, anxiety and reduced quality of life can be witnessed. The degree of severity of the depression and the life quality of ACTH-dependent group are worse than ACTH-independent CS patients.2. The activation of cerebellum, temporal lobe, frontal lobe and limbic system in CS group changed. It is related to cortisol level and its disordered rhythm. The damage of brain function with ACTH-dependent CS patients is much worse.3. Although a great improvement in psychiatric state, brain function and life quality can be drawn from the data of post-operational CS patients, they are far from full recovery compared with the healthy control group. |
PDF Full Text Request