A growing body of evidence suggests that altered brain structure plays a crucial role in the pathogenesis of neuropsychological abnormalities induced by hypercortisolism in patients with Cushing’s disease. While most studies mainly focus on gray matter, white matter structure has been largely overlooked. In the current study, we conducted a cross-sectional diffusion tensor imaging study on 58 patients with Cushing’s disease and 54 matched healthy individuals to profile the microstructural pattern using automated fiber quantification and investigate its association with neuroendocrine and neuropsychological deficits. The study revealed that microstructural pattern showed a widespread mean diffusivity, radial diffusivity increase, fractional anisotropy decrease and partial axial diffusivity increase among tracts notably in corpus callosum forceps, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, uncinate fasciculus and arcuate fasciculus, while within the same tract abnormalities localized to specific positions. Moreover, compromised microstructural pattern of white matter in specific tracts and locations along the trajectory were associated with ACTH and cortisol concentration and cognitive decline in patients with Cushing’s disease. Collectively, our study elucidates the form of white matter pathology induced by hypercortisolism and its association with cognitive decline which may provide further targets for early identification and intervention of Cushing’s disease.

越来越多的证据表明，大脑结构的改变在库欣病患者皮质醇增多症引起的神经心理异常的发病机制中起着至关重要的作用。虽然大多数研究主要集中在灰质上，但白质结构在很大程度上被忽视了。在当前的研究中，我们对 58 名库欣病患者和 54 名匹配的健康个体进行了横断面弥散张量成像研究，以使用自动纤维定量来描绘微观结构模式，并研究其与神经内分泌和神经心理缺陷的关联。研究表明，微观结构模式显示出广泛的平均扩散率、径向扩散率增加、分数各向异性减少和部分轴向扩散率增加，特别是在胼胝体钳、额枕下束、下纵束、上纵束、钩束和弓状束中。束，而同一束异常局限于特定位置。此外，沿着轨迹的特定区域和位置的白质微观结构模式受损与库欣病患者的 ACTH 和皮质醇浓度以及认知能力下降有关。总的来说，我们的研究阐明了皮质醇增多症引起的白质病理学形式及其与认知能力下降的关系，这可能为库欣病的早期识别和干预提供进一步的目标。