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Review
. 2022 Aug;34(8):e13142.
doi: 10.1111/jne.13142. Epub 2022 Aug 18.

Long-term effects of glucocorticoid excess on the brain

Alies J Dekkers  1   2 , Jorge Miguel Amaya  1 , Merel van der Meulen  1   2 , Nienke R Biermasz  1   2 , Onno C Meijer  1 , Alberto M Pereira  3
Affiliations
Review

Long-term effects of glucocorticoid excess on the brain

Alies J Dekkers et al. J Neuroendocrinol. 2022 Aug.

Abstract

The metabolic and cardiovascular clinical manifestations in patients with Cushing's syndrome (CS) are generally well known. However, recent studies have broadened the perspective of the effects of hypercortisolism, showing that both endogenous and exogenous glucocorticoid excess alter brain functioning on several time scales. Consequently, cognitive deficits and neuropsychological symptoms are highly prevalent during both active CS and CS in remission, as well as during glucocorticoid treatment. In this review, we discuss the effects of endogenous hypercortisolism and exogenously induced glucocorticoid excess on the brain, as well as the prevalence of cognitive and neuropsychological deficits and their course after biochemical remission. Furthermore, we propose possible mechanisms that may underly neuronal changes, based on experimental models and in vitro studies. Finally, we offer recommendations for future studies.

Keywords: Cushing; cognition; corticosteroid; glucocorticoid; neuroimaging; neuropsychology.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The effects of glucocorticoids and their potential effects on glucocorticoid (GR)/mineralocorticoid (MR) occupation in the brain. ACTH, adrenocorticotropic hormone; CRH, corticotropin‐releasing hormone; DEX, dexamethasone; cort., cortisol; GR, glucocorticoid receptor; MR, mineralocorticoid receptor. Adapted with permission from De Koning et al. 2021.
FIGURE 2
FIGURE 2
The influence of hypercortisolism on the brain. Adapted with permission from the Journal of Internal Medicine
See this image and copyright information in PMC

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