Relationship Between Dexamethasone Suppression Test Cortisol Level >0.9 μg/dL and Depression and Quality of Life in Adrenal Incidentalomas: A Single Center Observational Case-Control Study

Mutlu Güneş; Elif Güneş; Muhammet İlker Kaya; Hatice Demirci Küçükelyas; Hatice Barut; Sedat Öner

doi:10.1016/j.eprac.2024.05.002

Relationship Between Dexamethasone Suppression Test Cortisol Level >0.9 μg/dL and Depression and Quality of Life in Adrenal Incidentalomas: A Single Center Observational Case-Control Study

Endocr Pract. 2024 May 8:S1530-891X(24)00510-X. doi: 10.1016/j.eprac.2024.05.002. Online ahead of print.

Authors

Mutlu Güneş¹, Elif Güneş², Muhammet İlker Kaya³, Hatice Demirci Küçükelyas³, Hatice Barut⁴, Sedat Öner⁵

Affiliations

¹ Department of Endocrinology, Metabolism and Diabetes, Bursa Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey. Electronic address: drmutlugunes@gmail.com.
² Department of Endocrinology, Metabolism and Diabetes, Bursa State Hospital, Health Sciences University, Bursa, Turkey.
³ Department of Internal Medicine, Bursa State Hospital, Health Sciences University, Bursa, Turkey.
⁴ Department of Neurology, Bursa State Hospital, Health Sciences University, Bursa, Turkey.
⁵ Department of Urology, Bursa State Hospital, Health Sciences University, Bursa, Turkey.

PMID: 38729569
DOI: 10.1016/j.eprac.2024.05.002

Abstract

Objective: There has been increasing evidence that patients with adrenal incidentalomas (AIs) who have 1-mg dexamethasone suppression test (DST) cortisol levels >0.9 μg/dL may be exposed to the adverse consequences of hypercortisolaemia. We aim to evaluate whether there is a difference in Beck Depression Inventory-II (BDI-II) and quality of life (QoL) score in patients with AI based on the threshold of a DST cortisol level >0.9 μg/dL.

Methods: This case-control study included 42 nonfunctional adrenal incidentaloma (NFAI), 53 mild autonomic cortisol secretion (MACS) and 42 healthy controls (HCs). In addition, patients were categorized as ≤0.9 and >0.9 μg/dL according to their DST cortisol results.

Results: There was no difference in the QoL and BDI-II scores of MACS compared to NFAI. The BDI-II score was higher and QoL was lower in MACS and NFAI compared to HCs. The difference in QoL and BDI-II scores between MACS and NFAI remained insignificant when the DST cortisol levels threshold was graded upward (5.0 μg/dL). The prevalence of depression was higher in the AI >0.9 μg/dL group than the AI ≤0.9 μg/dL group (respectively, 16.7% and 55.8%, P = .003), BDI-II scores were higher in the AI >0.9 μg/dL group than in the AI ≤0.9 μg/dL group and HCs. The DST was an independent factor affecting the frequency of depression (odds ratio: 1.39, P = .037).

Conclusion: MACS and patients with NFAI had similar QoL and depression scores according to the 1.8 μg/dL and above, whereas, had lower QoL and higher depression scores according to the 0.9 μg/dL.

Keywords: 1 mg overnight dexamethasone suppression test; Beck Depression Inventory-II; Short Form 36 Health Survey; adrenal incidentaloma; mild autonomic cortisol secretion; quality of life.