Long-term effects of glucocorticoid excess on the brain

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.

Automated summary

The clinical manifestations of metabolism and cardiovascular system in patients with Cushing's syndrome are well-known. However, recent studies have shown that hypercortisolism, both endogenous and exogenous, affects brain functioning at different time scales. This review discusses the effects of hypercortisolism on the brain, the prevalence of cognitive and neuropsychological deficits, and their course after remission. Possible underlying neuronal changes are also proposed based on experimental models and in vitro studies. Recommendations for future studies are provided.