OBJECTIVES: I. Evaluate whether chronic hypercortisolemia is specifically toxic to
hippocampal cells and causes structural reduction of hippocampal volume in patients with
II. Determine whether reduced hippocampal volume is associated with specific memory
III. Examine the relationships of adrenal androgen to hippocampal volume and memory
IV. Examine the reversibility of hippocampal structural changes and cognitive dysfunction
after cortisol levels are normalized.
PROTOCOL OUTLINE: Patients undergo a psychiatric evaluation for mood and cognition during
confirmation of diagnosis. Neuropsychologic exams include pencil and paper test and a
Endocrine studies include dexamethasone and corticotropin-releasing hormone stimulation
tests. The hippocampal complex volume is assessed with coronal magnetic resonance imaging.
There is a follow-up 1 year after the initiation of treatment.
PROTOCOL ENTRY CRITERIA:
- Adults and teenagers with untreated, spontaneous active Cushing's syndrome
- Diagnosis verified at the University of Michigan Medical Center, including the
following: Excessive cortisol secretion measured by urinary-free cortisol, cortisol
secretion rate, and plasma cortisol level
- Lack of normal circadian cortisol secretion and failure to suppress following 2 mg of