title: Impaired decision-making and selective cortical frontal thinning in Cushing's syndrome.
abstract: OBJECTIVE
  Cushing's syndrome (CS) is caused by a glucocorticoid excess. This hypercortisolism can damage the prefrontal cortex, known to be important in decision-making. Our aim was to evaluate decision-making in CS and to explore cortical thickness.
  
  
  METHODS
  Thirty-five patients with CS (27 cured, eight medically treated) and thirty-five matched controls were evaluated using Iowa gambling task (IGT) and 3 Tesla magnetic resonance imaging (MRI) to assess cortical thickness. The IGT evaluates decision-making, including strategy and learning during the test. Cortical thickness was determined on MRI using freesurfer software tools, including a whole-brain analysis.
  
  
  RESULTS
  There were no differences between medically treated and cured CS patients. They presented an altered decision-making strategy compared to controls, choosing a lower number of the safer cards (P < 0·05). They showed more difficulties than controls to learn the correct profiles of wins and losses for each card group (P < 0·05). In whole-brain analysis, patients with CS showed decreased cortical thickness in the left superior frontal cortex, left precentral cortex, left insular cortex, left and right rostral anterior cingulate cortex, and right caudal middle frontal cortex compared to controls (P < 0·001).
  
  
  CONCLUSIONS
  Patients with CS failed to learn advantageous strategies and their behaviour was driven by short-term reward and long-term punishment, indicating learning problems because they did not use previous experience as a feedback factor to regulate their choices. These alterations in decision-making and the decreased cortical thickness in frontal areas suggest that chronic hypercortisolism promotes brain changes which are not completely reversible after endocrine remission.
authors: Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unidad 747), ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
authors: Iris
authors: I
authors: Crespo
authors: Granell-Moreno
authors: GM
authors: Esther
authors: Alicia
authors: A
authors: Santos
authors: Elena
authors: E
authors: Valassi
authors: Vives-Gilabert
authors: VG
authors: Yolanda
authors: Manel
authors: M
authors: De Juan-Delago
authors: Susan M
authors: SM
authors: Webb
authors: Beatriz
authors: B
authors: Gómez-Ansón
authors: Eugenia
authors: E
authors: Resmini
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000473:pathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000473:pathology* / Q000523:psychology; D003657:Decision Making; D056344:Executive Function; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D017397:Prefrontal Cortex / Q000473:pathology*