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

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: Single Centre Observational Case-Control Study Depression and Quality of Life in Adrenal Incidentalomas

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 Küçükelyas⁴, Hatice Barut⁵, Sedat Öner⁶

Affiliations

¹ Mutlu Güneş, At the time of writing, was an assistant professor at Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Endocrinology, Metabolism and Diabetes. Currently, an associate professor at Associate professor at Health Sciences University, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Endocrinology, Metabolism and Diabetes, Bursa, Turkey. Electronic address: drmutlugunes@gmail.com.
² Elif Güneş, MD, Health Sciences University, Bursa State Hospital, Department of Endocrinology, Metabolism and Diabetes, Bursa, Turkey.
³ Muhammet İlker Kaya, MD, Health Sciences University, Bursa State Hospital, Department of Internal Medicine, Bursa, Turkey.
⁴ Hatice Demirci Küçükelyas, MD, Health Sciences University, Bursa State Hospital, Department of Internal Medicine, Bursa, Turkey.
⁵ Hatice Barut, MD, Health Sciences University, Bursa State Hospital, Department of Neurology, Bursa, Turkey.
⁶ Sedat Öner, Associate Professor, MD, Health Sciences University, Bursa State Hospital, Department of Urology, Bursa, Turkey.

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

Abstract

Objective: There has been increasing evidence that patients with adrenal incidentalomas (AI) 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 AI patients based on the threshold of a DST cortisol level >0.9 μg/dL.

Methods: This case-control study included 42 non-functional AI (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 upwards (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=0.003), 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=0.037).

Conclusion: MACS and NFAI patients 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; Adrenal incidentaloma; Beck Depression Inventory-II; Short Form 36 Health Survey; mild autonomic cortisol secretion; quality of life.