Comparable cognitive impairment was detected in MACS and CS and alleviated after remission of hypercortisolism in MACS

Mengsi Liu; Wenji Zhao; Wei Zhang; Zhaoyang Tian; Zhou Zhang; Yuan Lou; Ziwei Zhang; Fan Yang; Dalong Zhu; Ping Li

doi:10.3389/fendo.2024.1373101

Comparable cognitive impairment was detected in MACS and CS and alleviated after remission of hypercortisolism in MACS

Front Endocrinol (Lausanne). 2024 Jul 31:15:1373101. doi: 10.3389/fendo.2024.1373101. eCollection 2024.

Authors

Mengsi Liu^#^{1

2

3}, Wenji Zhao^#^{1

3}, Wei Zhang^#^{1

3}, Zhaoyang Tian^{1

3}, Zhou Zhang^{1

3}, Yuan Lou^{1

3}, Ziwei Zhang^{1

3}, Fan Yang^{1

3}, Dalong Zhu^{1

2

3}, Ping Li^{1

3}

Affiliations

¹ Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
² Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Graduate School of Peking Union Medical College, Nanjing, China.
³ Nanjing Drum Tower Hospital, Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.

^# Contributed equally.

Abstract

Context: Few studies have directly compared the cognitive characteristics of patients with mild autonomous cortisol secretion (MACS) and Cushing's syndrome (CS). The effect of surgical or conservative treatment on cognitive function in patients with MACS is still unclear.

Objective: To compare the differences in cognitive function between patients with MACS and CS and evaluate the effect of surgery or conservative treatment on cognitive function.

Methods: We prospectively recruited 59 patients with nonfunctional adrenal adenoma (NFA), 36 patients with MACS, and 20 patients with adrenal CS who completed the global cognition and cognitive subdomains assessments. Seventeen MACS patients were re-evaluated for cognitive function after a 12-month follow-up period; of these, eleven underwent laparoscopic adrenalectomy and six received conservative treatment.

Results: Patients with MACS and CS performed worse in the global cognition and multiple cognitive domains than those with NFA (all P<0.05). No statistical difference was found in cognitive functions between patients with MACS and CS. Logistic regression analysis showed that patients with MACS (odds ratio [OR]=3.738, 95% confidence intervals [CI]: 1.329-10.515, P=0.012) and CS (OR=6.026, 95% CI: 1.411-25.730, P=0.015) were associated with an increased risk of immediate memory impairment. Visuospatial/constructional, immediate and delayed memory scores of MACS patients were significantly improved at 12 months compared with pre-operation in the surgical treatment group (all P<0.05), whereas there was no improvement in the conservative treatment group.

Conclusion: Patients with MACS have comparable cognitive impairment as patients with CS. Cognitive function was partially improved in patients with MACS after adrenalectomy. The current data support the inclusion of cognitive function assessment in the clinical management of patients with MACS.

Keywords: Cushing’s syndrome; adrenal incidentalomas; adrenalectomy; cognitive impairment; mild autonomous cortisol secretion.

MeSH terms

Adrenalectomy*
Adult
Cognitive Dysfunction* / etiology
Cushing Syndrome* / complications
Cushing Syndrome* / psychology
Cushing Syndrome* / surgery
Cushing Syndrome* / therapy
Female
Follow-Up Studies
Humans
Hydrocortisone / blood
Hydrocortisone / metabolism
Male
Middle Aged
Prospective Studies
Remission Induction

Substances

Hydrocortisone

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Key Research and Development Program of China (grant numbers 2022YFC2505300, 2022YFC2505306, 2021YFC2501600 and 2021YFC2501603) and the National Natural Science Foundation of China (grant number 81970689).