Depression: another cortisol-related comorbidity in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion

Purpose Hypercortisolism is associated with a high prevalence of depression and impaired health-related quality of life (QoL). According to the available literature, studies examining the depression risk in patients with adrenal incidentalomas (AI), nonfunctioning and the ones with (possible) autonomous cortisol secretion ((P)ACS) are scarce. The aim of this observational, case-control study was to screen patients with nonfunctioning adrenal incidentalomas (NAI) and the ones with (P)ACS for depression and to assess their QoL. Methods The total studied group consisted of 92 subjects-26 with NAI, 34 with (P)ACS and 32 age-matched healthy controls (HC). To screen for depression, we used the Beck Depression Inventory-II (BDI-II) and to assess the QoL, we used the Short-Form 36 Health Survey (SF-36). Results Patients with (P)ACS had significantly higher BDI-II scores and substantially lower QoL than patients with NAI or HC. Midnight cortisol level was the most significant predictor of BDI-II and SF-36 score. The receiver operating characteristic curve analysis demonstrated that a midnight cortisol value of 86.95 nmol/l had a high sensitivity (82.8%) and high specificity (80%) for detection of mild depression in patients with (P)ACS. Conclusion Screening for depression and QoL assessment should become an integral part of clinical evaluation in patients with (P)ACS.

Automated summary

Patients with (possible) autonomous cortisol secretion ((P)ACS) have higher risk of depression and lower quality of life compared to those with nonfunctioning adrenal incidentalomas (NAI) or healthy controls. Midnight cortisol level is a significant predictor of depression and quality of life. Therefore, screening for depression and assessing quality of life should be an integral part of clinical evaluation in (possible) autonomous cortisol secretion patients.