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Decreased Brain Glucose Utilization in Patients with Gushing's Disease

Neuroimaging Branch, Naples; Surgical Neurology Branch, Naples; National Institute of Neurological Disorders and Stroke, Naples; Nuclear Medicine Department, Naples; Clinical Center, Naples; Developmental Endocrinology Branch, Naples; National Institute of Child Health and Development, Naples; National Institutes of Health, Naples; Bethesda, Naples; Maryland, Naples; The Center for Nuclear Medicine, Naples; Consiglio Nazionale delle Ricerche, Naples; Università "Federico II," Naples, Naples, Italy

Correspondence: For correspondence or reprints contact: Arturo Brunetti, MD, CNR Center for Nuclear Medicine, Via Pansini 5-80131, Napoli, Italy.

ABSTRACT

Glucocorticoid hormones affect glucose use in different tissues, and the results of several experimental studies have suggested that glucocorticoids have a central action on cerebral metabolism. PET, using the radiotracer ¹⁸F-fluorodeoxyglucose (FDG), permits the measurement of cerebral glucose metabolism. Methods: To investigate whether cerebral glucose metabolism would be altered in patients with increased plasma glucocorticoid levels, we analyzed the FDG PET studies that were done on 13 patients with Cushing's disease and compared the results with those obtained in 13 age-matched normal control subjects. A second FDG PET scan was performed on 4 patients after surgical removal of the pituitary adenoma. Results: Patients with Cushing's disease had a significant reduction in cerebral glucose metabolism compared with normal controls. In the patients on whom a second PET scan was performed, there was a trend toward increased glucose metabolism on the second scan when comparing pre-and postsurgery values for each patient. Conclusion: We suggest that the decreased cerebral glucose metabolism we observed in Cushing's disease is attributable to increased glucocorticoid levels, and we speculate that abnormal cerebral glucose metabolism might contribute to the cognitive and psychiatric abnormalities that are frequently observed in patients with Cushing's disease.

Key Words: Cushing's disease • cerebral glucose metabolism • PET • glucocorticoids

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