Objective To review the main neuropsychiatric disorders and cognitive deficits in patients with Cushing＇s disease （CD） and the associated pathophysiological mechanisms underlying CD.These mechanistic details may provide recommendations for preventing or treating the cognitive impairments and mood disorders in patients with CD.Data sources Data were obtained from papers on psychiatric and cognitive complications in CD published in English within the last 20 years.To perform the PubMed literature search,the following keywords were input：cushing＇s disease,cognitive,hippocampal,or glucocorticoids.Study selection Studies were selected if they contained data relevant to the topic addressed in the particular section.Because of the limited length of this article,we have frequently referenced recent reviews that contain a comprehensive amalgamation of literature rather than the actual source papers.Results Patients with active CD not only suffer from many characteristic clinical features,but also show some neuropsychiatric disorders and cognitive impairments.Among the psychiatric manifestations,the common ones are emotional instability,depressive disorder,anxious symptoms,impulsivity,and cognitive impairment.Irreversible effects of previous glucocorticoid （GC） excess on the central nervous system,such as hippocampal and the basal ganglia,is the most reasonable reason.Excess secretion of cortisol brings much structural and functional changes in hippocampal,such as changes in neurogenesis and morphology,signaling pathway,gene expression,and glutamate accumulation.Hippocampal volume loss can be found in most patients with CD,and decreased glucose utilization caused by GCs may lead to brain atrophy,neurogenesis impairment,inhibition of long-term potentiation,and decreased neurotrophic factors; these may also explain the mechanisms of GC-induced brain atrophy and hippocampal changes.Conclusions Brain atrophy and hippocampal changes caused by excess secretion of cortisol are thought to play a significant pathophys
Background Cushing＇s disease （CD） presents a remarkable preponderance in female gender,and a significant minority of patients with CD presented with negative magnetic resonance imaging （MRI） findings.The aim of this study was to evaluate gender-related and MRI classification-related differences in clinical and biochemical characteristics of CD.Methods We retrospectively studied 169 patients with CD,comprising 132 females and 37 males,and 33 patients had no visible adenoma on MRI.Results We observed that male and MRI-positive patients presented with high adrenocorticotropic hormone （ACTH） values （P ＜0.05）.Female patients presented with higher prevalence of hirsutism and hyperpigmentation and lower prevalence of purple striae （P ＜0.05）.The prevalence of buffalo-hump and hypertension was greater in MRI-negative patients （P ＜0.05）.In addition,male patients with CD presented at a younger age compared with females （P ＜0.05）.Patients with fatigue and hypokalaemia presented significantly higher urinary-free cortisol,ACTH and cortisol levels compared with patients without these symptoms （P ＜0.05）.The prevalence of LH reduction,hyper total cholesterol （TC） and hyper low-density lipoprotein was more frequent in MRI-positive patients （P ＜0.05）.Hyper-TC levels and PRL reduction were more frequent in males （P ＜0.05）.T3,T4 and FT3 levels negatively correlated with age at diagnosis （r=-0.310,P ＜0.01; r=-0.191,P ＜0.05; r＝-0.216,P ＜0.05）.T3,T4,FT3 and FT4 levels significantly negatively correlated with 8-am plasma cortisol levels （r=-0.328,P ＜0.01; r=-0.195,P ＜0.05; r=-0.333,P ＜0.01; r＝-0.180,P ＜0.05）.Females presented higher total protein level （P ＜0.01） and lower blood urea nitrogen and serum creatinine levels （P ＜0.01）,compared with male patients.Conclusions Carefulness and caution are required in all patients with CD,because of the complexity of clinical and biochemical characteristics in CD patients of different gender and MRI cl
