Cognition in patients with mild autonomous cortisol secretion at baseline and post-adrenalectomy. Eur J Endocrinol 2024 Nov 27;191(6):636-645
Date
12/13/2024Pubmed ID
39671564Pubmed Central ID
PMC11662234DOI
10.1093/ejendo/lvae157Scopus ID
2-s2.0-85212919689 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
OBJECTIVES: The impact of mild autonomous cortisol secretion (MACS) on cognition is incompletely characterized. We aimed to assess cognition in patients with MACS, identify factors associated with lower cognition, and determine the impact of adrenalectomy on cognition.
METHODS: We conducted a cross-sectional study (4/2019 to 10/2022) and a longitudinal cohort study (10/2021 to 9/2023) of adults with MACS and referent subjects. Cognition was assessed with National Institute of Health Toolbox Cognition Battery and reported as standardized T scores (adjusted for age, sex, race/ethnicity, and education) for fluid, crystallized, and total composite cognition. Participants were assessed with urine steroid profiling (liquid chromatography-tandem mass spectrometry), frailty index, Beck's Depression Inventory (BDI), and Short Form-36 (SF-36).
RESULTS: A total of 84 patients (median age 57 years, 67% women) and 201 referent subjects (median age 63 years, 58% women) were included. Patients with MACS demonstrated lower mean (SD) total composite (50.9 [9.3] vs 55.4 [8.9], P < .001) and fluid composite T score (49.3 [10.6] vs 55.2 [10.2], P < .001), but not crystallized composite T score (52.3 [8.4] vs 54.0 [8.4], P = .130) when compared with referent subjects. Multivariable analysis adjusted for age, sex, BDI, SF-36, frailty index, total glucocorticoids, and androgens demonstrated that MACS status was associated with lower cognition. When cognition was reassessed in 37 patients post-adrenalectomy and 31 referent subjects, adjusted group differences of cognition change were similar except for a higher comparative increase in attention and executive functioning in patients with MACS.
CONCLUSION: Patients with MACS demonstrate lower cognition than referent subjects. Adrenalectomy for MACS had a minor positive impact on cognition.
Author List
Saini J, Nathani R, Singh S, Ebbehoj A, Thangamuthu K, Suresh M, Zhang CD, Nevin S, Fell V, Atkinson EJ, Achenbach SJ, Stricker NH, Bancos IAuthor
Catherine Zhang MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdrenalectomyAdult
Aged
Cognition
Cross-Sectional Studies
Female
Humans
Hydrocortisone
Longitudinal Studies
Male
Middle Aged
