The following is a summary of “Impaired Cognitive Function in Patients With Autonomous Cortisol Secretion in Adrenal Incidentalomas,” published in the March 2023 issue of Endocrinology & Metabolism by Liu, et al.

The central nervous system is significantly affected by glucocorticoids. While Cushing syndrome patients typically report cognitive impairments, investigations examining cognitive performance in individuals with autonomous cortisol secretion (ACS) in adrenal incidentalomas (AIs) are few and far between. For a study, researchers sought to investigate the effect of ACS on neurocognitive function in patients with AIs. 

A total of 126 patients were prospectively recruited, which included 63 patients with AI, 36 patients with nonfunctional adrenal adenoma (NFA) (mean age 46.5 ± 10.5 years), and 27 patients with ACS (mean age 48.6 ± 9.1 years). The patients underwent a series of neuropsychological tests to evaluate cognitive function. ACS was diagnosed when the cortisol level after a 1-mg dexamethasone suppression test (cortisol_{1 mg DST}) was ≥ 50 nmol/L.

The results of the study revealed that patients with ACS had a significantly higher frequency of subjective memory complaints (40.7% vs. 13.9%, P < 0.05) and a higher proportion of mild cognitive impairment (22.2% vs. 2.8%, P < 0.05) than patients with NFA. Additionally, patients with ACS performed worse on working memory and the visuospatial/constructional domain than patients with NFA (all P < 0.05). The cortisol_{1 mg DST} was negatively correlated with working memory and visuospatial/constructional domains (r = −0.307 and −0.306, respectively, all P < 0.05). Moreover, the performance on working memory and visuospatial/constructional domains gradually deteriorated with increasing cortisol1 mg DST levels (all P values for trend < 0.05). Multivariate linear regression analysis revealed that cortisol_{1 mg DST} was a significant risk factor for impairment of working memory and visuospatial/constructional domains (B = −0.006 and −0.043, respectively, all P < 0.05).

In conclusion, the study provides evidence that ACS is associated with impaired cognitive function, as indicated by increased subjective memory complaints and proportion of mild cognitive impairment, as well as worse performance on neuropsychological tests. Therefore, cognitive function evaluation should be included in the clinical assessment of patients with ACS.

Source: academic.oup.com/jcem/article/108/3/633/6763905