Saini Jasmine, Nathani Rohit, Singh Sumitabh, Ebbehoj Andreas, Thangamuthu Karthik, Suresh Malavika, Zhang Catherine D, Nevin Sophia, Fell Vanessa, Atkinson Elizabeth J, Achenbach Sara J, Stricker Nikki H, Bancos Irina
Division of Endocrinology, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, United States.
Department of Internal Medicine, UT Southwestern Medical Center, Texas 75235, United States.
Eur J Endocrinol. 2024 Nov 27;191(6):636-645. doi: 10.1093/ejendo/lvae157.
The impact of mild autonomous cortisol secretion (MACS) on cognition is incompletely characterized. We aimed to assess cognition in patients with MACS, identify factors associated with lower cognition, and determine the impact of adrenalectomy on cognition.
We conducted a cross-sectional study (4/2019 to 10/2022) and a longitudinal cohort study (10/2021 to 9/2023) of adults with MACS and referent subjects. Cognition was assessed with National Institute of Health Toolbox Cognition Battery and reported as standardized T scores (adjusted for age, sex, race/ethnicity, and education) for fluid, crystallized, and total composite cognition. Participants were assessed with urine steroid profiling (liquid chromatography-tandem mass spectrometry), frailty index, Beck's Depression Inventory (BDI), and Short Form-36 (SF-36).
A total of 84 patients (median age 57 years, 67% women) and 201 referent subjects (median age 63 years, 58% women) were included. Patients with MACS demonstrated lower mean (SD) total composite (50.9 [9.3] vs 55.4 [8.9], P < .001) and fluid composite T score (49.3 [10.6] vs 55.2 [10.2], P < .001), but not crystallized composite T score (52.3 [8.4] vs 54.0 [8.4], P = .130) when compared with referent subjects. Multivariable analysis adjusted for age, sex, BDI, SF-36, frailty index, total glucocorticoids, and androgens demonstrated that MACS status was associated with lower cognition. When cognition was reassessed in 37 patients post-adrenalectomy and 31 referent subjects, adjusted group differences of cognition change were similar except for a higher comparative increase in attention and executive functioning in patients with MACS.
Patients with MACS demonstrate lower cognition than referent subjects. Adrenalectomy for MACS had a minor positive impact on cognition.
轻度自主性皮质醇分泌（MACS）对认知的影响尚未完全明确。我们旨在评估MACS患者的认知情况，确定与认知水平较低相关的因素，并确定肾上腺切除术对认知的影响。
我们对患有MACS的成年人及对照受试者进行了一项横断面研究（2019年4月至2022年10月）和一项纵向队列研究（2021年10月至2023年9月）。使用美国国立卫生研究院工具箱认知电池对认知进行评估，并报告为液体、晶体和总综合认知的标准化T分数（根据年龄、性别、种族/民族和教育程度进行调整）。对参与者进行尿类固醇谱分析（液相色谱-串联质谱法）、衰弱指数、贝克抑郁量表（BDI）和简明健康状况调查量表（SF-36）评估。
共纳入84例患者（中位年龄57岁，67%为女性）和201例对照受试者（中位年龄63岁，58%为女性）。与对照受试者相比，MACS患者的平均（标准差）总综合T分数较低（50.9 [9.3] 对55.4 [8.9]，P <.001）和液体综合T分数较低（49.3 [10.6] 对55.2 [10.2]，P <.001），但晶体综合T分数无差异（52.3 [8.4] 对54.0 [8.4]，P =.130）。在对年龄、性别、BDI、SF-36、衰弱指数、总糖皮质激素和雄激素进行多变量分析后发现，MACS状态与较低的认知水平相关。在37例肾上腺切除术后患者和31例对照受试者中重新评估认知时，除MACS患者的注意力和执行功能相对增加较高外，调整后的认知变化组间差异相似。
MACS患者的认知水平低于对照受试者。肾上腺切除术对MACS患者的认知有轻微的积极影响。
