Mental Health in Patients With Adrenal Incidentalomas: Is There a Relation With Different Degrees of Cortisol Secretion?

Valentina Morelli, Alberto Ghielmetti, Alice Caldiroli, Silvia Grassi, Francesca Marzia Siri, Elisabetta Caletti, Francesco Mucci, Carmen Aresta, Elena Passeri, Flavia Pugliese, Annabella Di Giorgio, Sabrina Corbetta, Alfredo Scillitani, Maura Arosio, Massimiliano Buoli, Iacopo Chiodini, Valentina Morelli, Alberto Ghielmetti, Alice Caldiroli, Silvia Grassi, Francesca Marzia Siri, Elisabetta Caletti, Francesco Mucci, Carmen Aresta, Elena Passeri, Flavia Pugliese, Annabella Di Giorgio, Sabrina Corbetta, Alfredo Scillitani, Maura Arosio, Massimiliano Buoli, Iacopo Chiodini

Abstract

Context: Cushing's syndrome frequently causes mental health impairment. Data in patients with adrenal incidentaloma (AI) are lacking.

Objective: We aimed to evaluate psychiatric and neurocognitive functions in AI patients, in relation to the presence of subclinical hypercortisolism (SH), and the effect of adrenalectomy on mental health.

Design: We enrolled 62 AI patients (64.8 ± 8.9 years) referred to our centers. Subclinical hypercortisolism was diagnosed when cortisol after 1mg-dexamethasone suppression test was >50 nmol/L, in the absence of signs of overt hypercortisolism, in 43 patients (SH+).

Interventions: The structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders-5, and 5 psychiatric scales were performed. The Brief Assessment of Cognition in Schizophrenia (Verbal and Working Memory, Token and Symbol Task, Verbal Fluency, Tower of London) was explored in 26 patients (≤65 years).

Results: The prevalence of psychiatric disorders was 27.4% (SH+ 30.2% vs SH- 21.1%, P = 0.45). SH+ showed a higher prevalence of middle insomnia (by the Hamilton Depression Rating Scale) compared with SH- (51% vs 22%, P = 0.039). Considering the Sheehan Disability Scale, SH+ showed a higher disability score (7 vs 3, P = 0.019), higher perceived stress (4.2 ± 1.9 vs 2.9 ± 1.9, P = 0.015), and lower perceived social support (75 vs 80, P = 0.036) than SH-. High perceived stress was independently associated with SH (odds ratio [OR] = 5.46, confidence interval 95% 1.4-21.8, P = 0.016). Interestingly, SH+ performed better in verbal fluency (49.5 ± 38.9 vs 38.9 ± 9.0, P = 0.012), symbol coding (54.1 ± 6.7 vs 42.3 ± 15.5, P = 0.013), and Tower of London (15.1 vs 10.9, P = 0.009) than SH-. In 8 operated SH+, no significant changes were found.

Conclusions: Subclinical hypercortisolism may influence patients' mental health and cognitive performances, requiring an integrated treatment.

Keywords: adrenal incidentaloma; cognition; mental health; subclinical hypercortisolism.

© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society.

Figures

Figure 1.
Figure 1.
Enrolled patients after the application of exclusion criteria.
Figure 2.
Figure 2.
Tower of London task mean scores in 3 groups of patients according to cortisol levels after 1 mg DST: patients with cortisol ≤50 nmol/L (dark grey); patients with cortisol between 50 and 138 nmol/L (black); and patients with cortisol >138 nmol/L (light grey).

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