Mental Health in Patients with Adrenal Incidentalomas: Is There a Relation with Different Degrees of Cortisol Secretion?

V. Morelli, A. Ghielmetti, A. Caldiroli, S. Grassi, F.M. Siri, E. Caletti, F. Mucci, C. Aresta, E. Passeri, F. Pugliese, A. Di Giorgio, S. Corbetta, A. Scillitani, M. Arosio, M. Buoli, I. Chiodini

Research output: Contribution to journalArticlepeer-review


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

Original languageEnglish
Pages (from-to)E130-E139
JournalJ. Clin. Endocrinol. Metab.
Issue number1
Publication statusPublished - Jan 1 2021


  • adrenal incidentaloma
  • cognition
  • mental health
  • subclinical hypercortisolism
  • dexamethasone
  • hydrocortisone
  • adrenalectomy
  • adult
  • aged
  • Article
  • Brief Assessment of Cognition in Schizophrenia
  • disability
  • disease association
  • DSM-5
  • female
  • Hamilton Depression Rating Scale
  • human
  • hydrocortisone release
  • hypercortisolism
  • insomnia
  • major clinical study
  • male
  • mental disease
  • mental function
  • patient referral
  • Perceived Stress Scale
  • prevalence
  • priority journal
  • prospective study
  • Sheehan Disability Scale
  • social support
  • structured interview
  • token test
  • tower of London test
  • verbal communication
  • verbal fluency
  • verbal memory
  • working memory


Dive into the research topics of 'Mental Health in Patients with Adrenal Incidentalomas: Is There a Relation with Different Degrees of Cortisol Secretion?'. Together they form a unique fingerprint.

Cite this