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dc.contributor.authorWebb, EAen_US
dc.contributor.authorElliott, Len_US
dc.contributor.authorCarlin, Den_US
dc.contributor.authorWilson, Men_US
dc.contributor.authorHall, Ken_US
dc.contributor.authorNetherton, Jen_US
dc.contributor.authorReed, Jen_US
dc.contributor.authorBarrett, TGen_US
dc.contributor.authorSalwani, Ven_US
dc.contributor.authorClayden, JDen_US
dc.contributor.authorArlt, Wen_US
dc.contributor.authorKrone, Nen_US
dc.contributor.authorPeet, ACen_US
dc.contributor.authorWood, AGen_US
dc.coverage.spatialUnited Statesen_US
dc.date.accessioned2019-02-25T16:30:49Z
dc.date.issued2018-04-01en_US
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/29165577en_US
dc.identifier4642962en_US
dc.identifier.citationJ Clin Endocrinol Metab, 2018, 103 (4), pp. 1330 - 1341en_US
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/3092
dc.identifier.eissn1945-7197en_US
dc.identifier.doi10.1210/jc.2017-01481en_US
dc.description.abstractContext: Brain white matter hyperintensities are seen on routine clinical imaging in 46% of adults with congenital adrenal hyperplasia (CAH). The extent and functional relevance of these abnormalities have not been studied with quantitative magnetic resonance imaging (MRI) analysis. Objective: To examine white matter microstructure, neural volumes, and central nervous system (CNS) metabolites in CAH due to 21-hydroxylase deficiency (21OHD) and to determine whether identified abnormalities are associated with cognition, glucocorticoid, and androgen exposure. Design, Setting, and Participants: A cross-sectional study at a tertiary hospital including 19 women (18 to 50 years) with 21OHD and 19 age-matched healthy women. Main Outcome Measure: Recruits underwent cognitive assessment and brain imaging, including diffusion weighted imaging of white matter, T1-weighted volumetry, and magnetic resonance spectroscopy for neural metabolites. We evaluated white matter microstructure by using tract-based spatial statistics. We compared cognitive scores, neural volumes, and metabolites between groups and relationships between glucocorticoid exposure, MRI, and neurologic outcomes. Results: Patients with 21OHD had widespread reductions in white matter structural integrity, reduced volumes of right hippocampus, bilateral thalami, cerebellum, and brainstem, and reduced mesial temporal lobe total choline content. Working memory, processing speed, and digit span and matrix reasoning scores were reduced in patients with 21OHD, despite similar education and intelligence to controls. Patients with 21OHD exposed to higher glucocorticoid doses had greater abnormalities in white matter microstructure and cognitive performance. Conclusion: We demonstrate that 21OHD and current glucocorticoid replacement regimens have a profound impact on brain morphology and function. If reversible, these CNS markers are a potential target for treatment.en_US
dc.format.extent1330 - 1341en_US
dc.languageengen_US
dc.language.isoengen_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.subjectAdolescenten_US
dc.subjectAdrenal Hyperplasia, Congenitalen_US
dc.subjectAdulten_US
dc.subjectBrainen_US
dc.subjectCholineen_US
dc.subjectCognitionen_US
dc.subjectCross-Sectional Studiesen_US
dc.subjectDose-Response Relationship, Drugen_US
dc.subjectFemaleen_US
dc.subjectGlucocorticoidsen_US
dc.subjectHumansen_US
dc.subjectMagnetic Resonance Imagingen_US
dc.subjectMagnetic Resonance Spectroscopyen_US
dc.subjectMiddle Ageden_US
dc.subjectNeuropsychological Testsen_US
dc.subjectPsychometricsen_US
dc.subjectQuality of Lifeen_US
dc.subjectYoung Adulten_US
dc.titleQuantitative Brain MRI in Congenital Adrenal Hyperplasia: In Vivo Assessment of the Cognitive and Structural Impact of Steroid Hormones.en_US
dc.typeJournal Article
dcterms.dateAccepted2017-11-09en_US
rioxxterms.versionofrecord10.1210/jc.2017-01481en_US
rioxxterms.licenseref.startdate2018-04-01en_US
rioxxterms.typeJournal Article/Reviewen_US
dc.relation.isPartOfJ Clin Endocrinol Metaben_US
pubs.issue4en_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Magnetic Resonance
pubs.publication-statusPublisheden_US
pubs.volume103en_US
pubs.embargo.termsNot knownen_US
icr.researchteamMagnetic Resonanceen_US
dc.contributor.icrauthorCarlin, Dominicen_US


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