RESUMO
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 (64.8â ±â 8.9 years) referred to our centers. Subclinical hypercortisolism was diagnosed when cortisol after 1mg-dexamethasone suppression test wasâ >50 nmol/L, in the absence of signs of overt hypercortisolism, in 43 patients (SH+). INTERVENTIONS: The structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders-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 years). RESULTS: The prevalence of psychiatric disorders was 27.4% (SH+â 30.2% vs SH- 21.1%, Pâ =â 0.45). SH+â showed a higher prevalence of middle insomnia (by the Hamilton Depression Rating Scale) compared with SH- (51% vs 22%, Pâ =â 0.039). Considering the Sheehan Disability Scale, SH+â showed a higher disability score (7 vs 3, Pâ =â 0.019), higher perceived stress (4.2â ±â 1.9 vs 2.9â ±â 1.9, Pâ =â 0.015), and lower perceived social support (75 vs 80, Pâ =â 0.036) than SH-. High perceived stress was independently associated with SH (odds ratio [OR]â =â 5.46, confidence interval 95% 1.4-21.8, Pâ =â 0.016). Interestingly, SH+â performed better in verbal fluency (49.5â ±â 38.9 vs 38.9â ±â 9.0, Pâ =â 0.012), symbol coding (54.1â ±â 6.7 vs 42.3â ±â 15.5, Pâ =â 0.013), and Tower of London (15.1 vs 10.9, Pâ =â 0.009) than SH-. In 8 operated SH+,â no significant changes were found. CONCLUSIONS: Subclinical hypercortisolism may influence patients' mental health and cognitive performances, requiring an integrated treatment.