Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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.
Front Endocrinol (Lausanne). 2024 Jul 31;15:1373101. doi: 10.3389/fendo.2024.1373101. eCollection 2024.
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.
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.
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.
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.
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.
很少有研究直接比较轻度自主皮质醇分泌（MACS）和库欣综合征（CS）患者的认知特征。手术或保守治疗对 MACS 患者认知功能的影响尚不清楚。
比较 MACS 和 CS 患者认知功能的差异，并评估手术或保守治疗对认知功能的影响。
我们前瞻性招募了 59 例无功能性肾上腺腺瘤（NFA）患者、36 例 MACS 患者和 20 例肾上腺 CS 患者，完成了整体认知和认知子领域评估。17 例 MACS 患者在 12 个月随访后重新评估认知功能；其中 11 例行腹腔镜肾上腺切除术，6 例接受保守治疗。
MACS 和 CS 患者的整体认知和多个认知领域的认知功能均明显差于 NFA 患者（均 P<0.05）。MACS 和 CS 患者的认知功能无统计学差异。Logistic 回归分析显示，MACS 患者（比值比[OR]=3.738，95%置信区间[CI]：1.329-10.515，P=0.012）和 CS 患者（OR=6.026，95%CI：1.411-25.730，P=0.015）发生即刻记忆障碍的风险增加。手术治疗组 MACS 患者的视空间/结构、即刻和延迟记忆评分在术后 12 个月时与术前相比明显改善（均 P<0.05），而保守治疗组无改善。
MACS 患者的认知障碍与 CS 患者相当。肾上腺切除术后 MACS 患者的认知功能部分改善。目前的数据支持将认知功能评估纳入 MACS 患者的临床管理。
