Impaired Cognitive Function in ACS

Meng-si Liu, Zhao-yang Tian, Zhou Zhang, Fan Yang, Yuan Lou, Yi-jie Wang, Yang-jie Zeng, Zi-wei Zhang, Da-long Zhu, Ping Li
The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 3, March 2023, Pages 633–641
https://doi.org/10.1210/clinem/dgac603

Abstract

Context

Glucocorticoids have potent effects on the central nervous system. However, while patients with Cushing syndrome frequently report impairments in cognitive function, studies investigating cognitive function in patients with autonomous cortisol secretion (ACS) in adrenal incidentalomas (AIs) are scarce.

Objective

The aim of the present study was to evaluate neurocognitive function in patients with ACS.

Methods

We prospectively recruited 63 patients with AI, 36 patients with nonfunctional adrenal adenoma (NFA) (46.5 ± 10.5 years), and 27 patients with ACS (48.6 ± 9.1 years); these patients underwent a battery of validated neuropsychological tests. ACS was diagnosed when serum cortisol levels after a 1-mg dexamethasone suppression test (cortisol_{1 mg DST}) ≥ 50 nmol/L.

Results

Patients with ACS had higher frequency of subjective memory complaints (40.7% vs 13.9%, P < 0.05) and higher proportion of mild cognitive impairment (22.2% vs 2.8%, P < 0.05) than patients with NFA. Furthermore, patients with ACS had worse performance on working memory and the visuospatial/constructional domain than patients with NFA (all P < 0.05). Serum 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). Performance on working memory and visuospatial/constructional domains gradually deteriorated with increases in serum cortisol_{1 mg DST} (all P values for trend < 0.05). Multivariate linear regression analysis showed that serum 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).

Conclusion

This study is the first to report that ACS is accompanied by impaired cognitive function. Consequently, cognitive function assessment should be incorporated into the clinical evaluation of patients with ACS.

Clinical trial registration number

NCT05357456.

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