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

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...

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Published in:The journal of clinical endocrinology and metabolism 2021-01, Vol.106 (1), p.e130-e139
Main Authors: Morelli, Valentina, Ghielmetti, Alberto, Caldiroli, Alice, Grassi, Silvia, Siri, Francesca Marzia, Caletti, Elisabetta, Mucci, Francesco, Aresta, Carmen, Passeri, Elena, Pugliese, Flavia, Di Giorgio, Annabella, Corbetta, Sabrina, Scillitani, Alfredo, Arosio, Maura, Buoli, Massimiliano, Chiodini, Iacopo
Format: Article
Language:English
Subjects:
Adrenal Gland Neoplasms - blood
Adrenal Gland Neoplasms - epidemiology
Adrenal Gland Neoplasms - metabolism
Adrenal Gland Neoplasms - psychology
Adrenalectomy
Adult
Aged
Asymptomatic Diseases
Care and treatment
Clinical s
Cognition
Cognition Disorders - blood
Cognition Disorders - diagnosis
Cognition Disorders - epidemiology
Cognition Disorders - etiology
Cognitive ability
Cohort Studies
Cortisol
Cushing Syndrome - complications
Cushing Syndrome - diagnosis
Cushing Syndrome - epidemiology
Cushing Syndrome - psychology
Dexamethasone
Female
Hormones
Humans
Hydrocortisone - blood
Hydrocortisone - metabolism
Interview, Psychological
Italy - epidemiology
Language
Male
Mental disorders
Mental Disorders - blood
Mental Disorders - diagnosis
Mental Disorders - epidemiology
Mental Disorders - etiology
Mental Health
Mental task performance
Middle Aged
Neural coding
Neuropsychological Tests
Patients
Prevalence
Risk Factors
Schizophrenia
Sleep disorders
Social interactions
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Summary: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.
ISSN:0021-972X
1945-7197
DOI:10.1210/clinem/dgaa695