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

Abstract

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. 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. 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). 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.