Metabolic activity in the insular cortex and hypothalamus predicts hot flashes

An FDG-PET study

Hadine Joffe, Thilo Deckersbach, Nancy U. Lin, Nikos Makris, Todd Skaar, Scott L. Rauch, Darin D. Dougherty, Janet E. Hall

Research output: Contribution to journalArticle

14 Citations (Scopus)

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 estrogenfeedback (P=0.007) regionswaslower inwomenwhoreported 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.

Original languageEnglish
Pages (from-to)3207-3215
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume97
Issue number9
DOIs
StatePublished - Sep 2012

Fingerprint

beta-Aminoethyl Isothiourea
Hot Flashes
Positron emission tomography
Positron-Emission Tomography
Cerebral Cortex
Hypothalamus
Cytochrome P-450 CYP2D6
Glucose
Tamoxifen
Leuprolide
Aromatase Inhibitors
Fluorodeoxyglucose F18
Magnetic resonance
Polymorphism
Brain
Estrogens
Feedback
Imaging techniques

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Metabolic activity in the insular cortex and hypothalamus predicts hot flashes : An FDG-PET study. / Joffe, Hadine; Deckersbach, Thilo; Lin, Nancy U.; Makris, Nikos; Skaar, Todd; Rauch, Scott L.; Dougherty, Darin D.; Hall, Janet E.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 97, No. 9, 09.2012, p. 3207-3215.

Research output: Contribution to journalArticle

Joffe, Hadine ; Deckersbach, Thilo ; Lin, Nancy U. ; Makris, Nikos ; Skaar, Todd ; Rauch, Scott L. ; Dougherty, Darin D. ; Hall, Janet E. / Metabolic activity in the insular cortex and hypothalamus predicts hot flashes : An FDG-PET study. In: Journal of Clinical Endocrinology and Metabolism. 2012 ; Vol. 97, No. 9. pp. 3207-3215.
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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 estrogenfeedback (P=0.007) regionswaslower inwomenwhoreported 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.",
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T1 - Metabolic activity in the insular cortex and hypothalamus predicts hot flashes

T2 - An FDG-PET study

AU - Joffe, Hadine

AU - Deckersbach, Thilo

AU - Lin, Nancy U.

AU - Makris, Nikos

AU - Skaar, Todd

AU - Rauch, Scott L.

AU - Dougherty, Darin D.

AU - Hall, Janet E.

PY - 2012/9

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N2 - 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 estrogenfeedback (P=0.007) regionswaslower inwomenwhoreported 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.

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