Endocrine Abstracts

JOINT756

Objective: To explore the personality profile and behavior of patients with Cushing’s disease (CD) and their neurostructural correlates.

Methods: This study included CD (n = 38) and control (n = 29) groups. Controls were selected from volunteers who applied to hospital for routine tests between 2021-2022. Volunteers with signs suggestive of CD, exposed to glucocorticoids, and had uncontrolled diabetes and/or hypertension were excluded. Group-matching was performed for age, sex, and education. Psychometric assessments included Temperament and Character Inventory (TCI), Symptom Checklist-90-Revised (SCL-90-R), Buss-Perry Aggression Questionnaire (BPAQ), and Apathy Scale. Cortical thickness was examined using 3T magnetic resonance imaging. Surface-based morphometry was employed using the CAT12 toolbox. Least Absolute Shrinkage and Selection Operator (LASSO) was used to identify predictors of personality dimensions.

Results: Psychometric assessments revealed no differences in SCL-90-R (P >0.05 for all domains). TCI scores were similar between groups except for higher persistence in the CD group (6 [4–7] vs. 5 [3.5–6], P = 0.019). Total BPAQ scores were lower in the CD group (51 [46–60.5] vs. 66 [50–80.5], P = 0.011), indicating decreased aggression. Radiological analyses revealed cortical thinning in frontal and parietal regions in CD group. In left hemisphere, the largest cluster (P = 0.039, size = 3,418 voxels) showed thinning predominantly in rostral middle frontal (32%), precentral (14%), postcentral (10%), and superior frontal (10%) cortices. Thinning in this cluster was negatively correlated with cortisol (r=-0.528, P = 0.024), adrenocorticotropic hormone (ACTH) (r=-0.641, P = 0.004), and urinary free cortisol (UFC) (r=-0.546, P = 0.022). In right hemisphere, two clusters were identified. Cluster 1 (P = 0.026, size=6,098 voxels) predominantly involved the rostral middle frontal (23%) and superior frontal (19%) regions. Right Cluster 1 thinning was negatively correlated with cortisol (r=-0.538, P = 0.021), ACTH (r=-0.604, P = 0.008), and UFC (r=-0.474, P = 0.047). Right Cluster 2 (P = 0.037, size=5,481 voxels) exhibited thinning in the inferior parietal (22%), superior parietal (20%), and precuneus (16%) cortices. Thinning in right Cluster 2 correlated negatively with serum cortisol (r=-0.581, P = 0.011) and ACTH (r=-0.721, P < 0.001). LASSO analysis identified the CD, older age, and cortical thinning in Cluster 1 as predictors of reduced aggression. Thinning Cluster 1 emerged as the strongest predictor of lower aggression.

Conclusion: CD might promote persistence and suppress aggression. Neuroimaging revealed thinning in bilateral frontal and right parietal cortex in CD group. Neurostructural changes became more evident with higher cortisol levels. Thinning in the right rostral middle frontal, superior frontal, and precentral gyri emerged as determinants of aggression, highlighting the role of neurostructural changes in shaping behavior in CD.