, Volume 20, Issue 3, pp 340–348 | Cite as

White matter involvement on DTI-MRI in Cushing’s syndrome relates to mood disturbances and processing speed: a case-control study

  • Patricia Pires
  • Alicia Santos
  • Yolanda Vives-Gilabert
  • Susan M. Webb
  • Aitor Sainz-Ruiz
  • Eugenia Resmini
  • Iris Crespo
  • Manel de Juan-Delago
  • Beatriz Gómez-AnsonEmail author



Cushing’s syndrome (CS) is an endocrine disorder due to prolonged exposure to cortisol. Recently, microstructural white matter (WM) alterations detected by diffusion tensor imaging (DTI) have been reported in CS patients, and related to depression, but other functional significances. remain otherwise unclear. We aimed at investigating in more depth mood symptoms in CS patients, and how these relate to cognition (information processing speed), and to WM alterations on DTI.


The sample comprised 35 CS patients and 35 healthy controls. Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, State-Trait Anxiety Inventory (STAI) to assess anxiety, and processing speed was measured by the Symbol Digit Modalities Test (SDMT). DTI studies were acquired using a 3-Tesla Philips-Achieva MR-facility. Voxelwise statistical analysis of fractional anisotropy (FA), mean, axial and radial diffusivities (MD, AD, RD) data were performed using FMRIB Software Library. Correlation analysis were obtained between mood and processing speed variables, and FA, MD, AD and RD values, taking both CS patients and healthy controls.


Active, controlled and cured CS patients showed greater depression (F = 12.4, p < 0.001), anxious state (F = 4.8, p = 0.005) and anxious trait (F = 9.6, p < 0.001) scores, than controls. Using the entire sample, depression scores correlated negatively to FA and positively to RD values. Although there were no differences in processing speed between groups, SDMT scores correlated positively to both FA and AD values.


There were greater depressive and anxious symptoms in CS patients than in healthy controls, but no difference in processing speed. However, DTI is related to depression and information processing speed in CS.


Cushing syndrome Depression Anxiety DTI Brain white matter 



We want to thank patients and healthy volunteers who participated in the current study for their kind cooperation.


This project was supported by grants from ISCIII, Spanish Ministry of Science and Innovation (MICINN, FIS080302 and FIS 070770) and the European Commission (ERCUSYN PHP800200).

Compliance with ethical standards

Conflict of interest

Patricia Pires, Alicia Santos, Yolanda Vives-Gilabert, Susan Webb, Aitor Sainz-Ruiz, Eugenia Resmini declares, Iris Crespo, Manuel de Juan-Delago and Beatriz Gómez-Ansón declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.INNDACYTSant Feliu de LlobregatSpain
  2. 2.Endocrinology/Medicine Departments, Hospital Sant PauUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
  3. 3.Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747)ISCIII and Universitat Autònoma de Barcelona (UAB)BarcelonaSpain
  4. 4.Port d’Informació Científica (PIC), Campus UAB Edifici DBarcelonaSpain
  5. 5.Institut de Fisica d’Altes Energies (IFAE)Campus UAB Edifici CBarcelonaSpain
  6. 6.Neuroradiology Unit, Hospital Sant PauIIB-Sant Pau, and UABBarcelonaSpain

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