Question: I’ve heard that some doctors are starting to do neuropsychological testing during Cushing’s and then during remission to help the patient understand how cognitive, memory, and other brain-related operations are affected by excess cortisol. Can any psychology department conduct this testing or would I need to seek out a specialist if my endocrinologist doesn’t have a partnership with a neuropsychology department? How are doctors using the results of this type of testing to help patients?
Answer: Cortisol receptors are present in the brain and cortisol excess can cause a wide array of mood and cognitive changes. Neuropsychological testing is important in patients with Cushing’s syndrome who experience these problems especially that some problems may persist to some extent after cortisol normalizes. The neuropsychological evaluation is done by trained neuropsychologists. Some pituitary centers have collaborations with neuropsychologists from the same institution. If this is not available, patients may see a neurologist or psychiatrist who can provide further guidance and referrals.
Neuropsychological results are useful in several ways: 1. accurate diagnosis of the mood and cognitive problems and their severity, 2. guidance regarding management (which may include observation, counseling, seeing a psychiatrist, etc) and 3. tracking the progress by repeat evaluations.
By Dr. Adriana Ioachimescu, Emory University Hospital, Atlanta, GA (Winter-Spring 2018)