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

Emma Webb, Lucy Elliot, Dominic Carlin, Martin Wilson, Kirsty Hall, Jennifer Netherton, Julie Reed, Timothy G. Barrett, VIjay Sawlani, Jon Clayden, Wiebke Arlt , N. Krone, Andrew Peet, Amanda Wood

Research output: Contribution to journalArticle

Abstract

Abstract
Context
Brain white matter hyper-intensities 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 using quantitative MRI analysis.
Objective
To examine white matter microstructure, neural volumes and 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 females (18-50 years) with 21OHD and 19 age-matched healthy females.
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 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. 21OHD individuals exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance.
Conclusion
For the first time we demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers represent a potential target for treatment.
Original languageEnglish
Pages (from-to)1330-1341
JournalJournal of Clinical Endocrinology and Metabolism
Volume103
Issue number4
Early online date20 Nov 2017
DOIs
Publication statusE-pub ahead of print - 20 Nov 2017

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Steroid hormones
Congenital Adrenal Hyperplasia
Magnetic resonance imaging
Glucocorticoids
Brain
Metabolites
Steroids
Hormones
Microstructure
Magnetic resonance spectroscopy
Steroid 21-Hydroxylase
Imaging techniques
Medical imaging
Structural integrity
Choline
Androgens
Education
Statistics
Temporal Lobe
Thalamus

Bibliographical note

This article has been published under the terms of the Creative Commons Attribution
License (CC BY; https://creativecommons.org/licenses/by/4.0/), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited. Copyright for this article is retained by the author(s).

Cite this

Webb, Emma ; Elliot, Lucy ; Carlin, Dominic ; Wilson, Martin ; Hall, Kirsty ; Netherton, Jennifer ; Reed, Julie ; Barrett, Timothy G. ; Sawlani, VIjay ; Clayden, Jon ; Arlt , Wiebke ; Krone, N. ; Peet, Andrew ; Wood, Amanda. / Quantitative MRI brain in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones. In: Journal of Clinical Endocrinology and Metabolism . 2017 ; Vol. 103, No. 4. pp. 1330-1341.
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abstract = "AbstractContextBrain white matter hyper-intensities 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 using quantitative MRI analysis.ObjectiveTo examine white matter microstructure, neural volumes and 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 participantsA cross-sectional study at a tertiary hospital including 19 females (18-50 years) with 21OHD and 19 age-matched healthy females.Main outcome measureRecruits 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 using tract-based spatial statistics. We compared cognitive scores, neural volumes and metabolites between groups and relationships between glucocorticoid exposure, MRI and neurologic outcomes.ResultsPatients 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. 21OHD individuals exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance.ConclusionFor the first time we demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers represent a potential target for treatment.",
author = "Emma Webb and Lucy Elliot and Dominic Carlin and Martin Wilson and Kirsty Hall and Jennifer Netherton and Julie Reed and Barrett, {Timothy G.} and VIjay Sawlani and Jon Clayden and Wiebke Arlt and N. Krone and Andrew Peet and Amanda Wood",
note = "This article has been published under the terms of the Creative Commons Attribution License (CC BY; https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Copyright for this article is retained by the author(s).",
year = "2017",
month = "11",
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Webb, E, Elliot, L, Carlin, D, Wilson, M, Hall, K, Netherton, J, Reed, J, Barrett, TG, Sawlani, VI, Clayden, J, Arlt , W, Krone, N, Peet, A & Wood, A 2017, 'Quantitative MRI brain 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. https://doi.org/10.1210/jc.2017-01481

Quantitative MRI brain in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones. / Webb, Emma; Elliot, Lucy; Carlin, Dominic; Wilson, Martin; Hall, Kirsty; Netherton, Jennifer; Reed, Julie; Barrett, Timothy G.; Sawlani, VIjay; Clayden, Jon; Arlt , Wiebke; Krone, N.; Peet, Andrew; Wood, Amanda.

In: Journal of Clinical Endocrinology and Metabolism , Vol. 103, No. 4, 20.11.2017, p. 1330-1341.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Quantitative MRI brain in congenital adrenal hyperplasia: in vivo assessment of the cognitive and structural impact of steroid hormones

AU - Webb, Emma

AU - Elliot, Lucy

AU - Carlin, Dominic

AU - Wilson, Martin

AU - Hall, Kirsty

AU - Netherton, Jennifer

AU - Reed, Julie

AU - Barrett, Timothy G.

AU - Sawlani, VIjay

AU - Clayden, Jon

AU - Arlt , Wiebke

AU - Krone, N.

AU - Peet, Andrew

AU - Wood, Amanda

N1 - This article has been published under the terms of the Creative Commons Attribution License (CC BY; https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Copyright for this article is retained by the author(s).

PY - 2017/11/20

Y1 - 2017/11/20

N2 - AbstractContextBrain white matter hyper-intensities 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 using quantitative MRI analysis.ObjectiveTo examine white matter microstructure, neural volumes and 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 participantsA cross-sectional study at a tertiary hospital including 19 females (18-50 years) with 21OHD and 19 age-matched healthy females.Main outcome measureRecruits 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 using tract-based spatial statistics. We compared cognitive scores, neural volumes and metabolites between groups and relationships between glucocorticoid exposure, MRI and neurologic outcomes.ResultsPatients 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. 21OHD individuals exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance.ConclusionFor the first time we demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers represent a potential target for treatment.

AB - AbstractContextBrain white matter hyper-intensities 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 using quantitative MRI analysis.ObjectiveTo examine white matter microstructure, neural volumes and 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 participantsA cross-sectional study at a tertiary hospital including 19 females (18-50 years) with 21OHD and 19 age-matched healthy females.Main outcome measureRecruits 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 using tract-based spatial statistics. We compared cognitive scores, neural volumes and metabolites between groups and relationships between glucocorticoid exposure, MRI and neurologic outcomes.ResultsPatients 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. 21OHD individuals exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance.ConclusionFor the first time we demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers represent a potential target for treatment.

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DO - 10.1210/jc.2017-01481

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SP - 1330

EP - 1341

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

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