Mental health in patients with adrenal incidentalomas: is there a relation with different degrees of cortisol secretion?

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 yrs) referred to our Centers. SH 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 DSM-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 yrs). 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 Hamilton Depression Rating Scale) compared to SH- (51% vs 22%, p=0.039). Considering Sheehan Disability Scale, SH+ showed 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-. A high perceived stress was independently associated with SH (OR=5.46, CI95% 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 SH may influence patients’ mental health and cognitive performances requiring an integrate treatment.