☆ 4.7 Article

Metabolic Activity in the Insular Cortex and Hypothalamus Predicts Hot Flashes: An FDG-PET Study

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM (2012)

Journal

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM

Volume 97, Issue 9, Pages 3207-3215

Publisher

ENDOCRINE SOC

DOI: 10.1210/jc.2012-1413

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Funding

Harvard Medical School Fund for Women's Health, Friends of Dana-Farber Cancer Institute
Massachusetts General Hospital Claflin Distinguished Scholar Award
NIMH
NIH
Cephalon
Tufts University
Janssen Pharmaceuticals
Forest Research Institute
Shire Development Inc.
Medtronic
Cyberonics
Northstar
MGH Psychiatry Academy
BrainCells Inc.
Systems Research and Applications Corporation
Boston University
National Association of Social Workers Massachusetts
Massachusetts Medical Society
Oxford University Press

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Abstract

Context: Hot flashes are a common side effect of adjuvant endocrine therapies (AET; leuprolide, tamoxifen, aromatase inhibitors) that reduce quality of life and treatment adherence in breast cancer patients. Because hot flashes affect only some women, preexisting neurobiological traits might predispose to their development. Previous studies have implicated the insula during the perception of hot flashes and the hypothalamus in thermoregulatory dysfunction. Objective: The aim of the study was to understand whether neurobiological factors predict hot flashes. Design: [18F]-Fluorodeoxyglucose (FDG) positron emission tomography (PET) brain scans coregistered with structural magnetic resonance imaging were used to determine whether metabolic activity in the insula and hypothalamic thermoregulatory and estrogen-feedback regions measured before and in response to AET predict hot flashes. Findings were correlated with CYP2D6 genotype because of CYP2D6 polymorphism associations with tamoxifen-induced hot flashes. Outcome Measures: We measured regional cerebral metabolic rate of glucose uptake (rCMRglu) in the insula and hypothalamus on FDG-PET. Results: Of 18 women without hot flashes who began AET, new-onset hot flashes were reported by 10 (55.6%) and were detected objectively in nine (50%) participants. Prior to the use of all AET, rCMRglu in the insula (P <= 0.01) and hypothalamic thermoregulatory (P = 0.045) and estrogen-feedback (P = 0.007) regions was lower in women who reported developing hot flashes. In response to AET, rCMRglu was further reduced in the insula in women developing hot flashes (P <= 0.02). Insular and hypothalamic rCMRglu levels were lower in intermediate than extensive CYP2D6 metabolizers. Conclusions: Trait neurobiological characteristics predict hot flashes. Genetic variability in CYP2D6 may underlie the neurobiological predisposition to hot flashes induced by AET. (J Clin Endocrinol Metab 97: 3207-3215, 2012)

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Amygdalar activity measured using FDG-PET/CT at head and neck cancer staging independently predicts survival

Malek Z. O. Hassan, Ahmed Tawakol, Ying Wang, Raza M. Alvi, Magid Awadalla, Maeve Jones-O'Connor, Rula B. Bakar, Dahlia Banerji, Adam Rokicki, Lili Zhang, Connor P. Mulligan, Michael T. Osborne, Azmaeen Zarif, Basma Hammad, Annie W. Chan, Lori J. Wirth, Erica T. Warner, Roger K. Pitman, Katrina A. Armstrong, Daniel Addison, Tomas G. Neilan

Summary: The mechanisms linking chronic stress and higher mortality in individuals with cancer are not fully understood. This retrospective cohort study found that higher stress-associated neural activity in individuals with head and neck cancer was associated with poorer survival. Future research should investigate strategies to reduce this neural activity and improve cancer survival.

PLOS ONE (2023)