ECE2018 Guided Posters Adrenal cortex (10 abstracts)
The need for depression screening in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion – the role of integrated care
Ljiljana Marina 1, , Miomira Ivovic 1, , Milina Tancic-Gajic 1, , Zorana Arizanovic 1 , Antoan Stefan Sojat 2 , Srdjan Pandurevic 2 , Nevena Radonjic 3 , Bojana Dunjic-Kostic 4 , Andja Cirkovic 5 , Aleksandra Kendereski 1, , Dragan Micic 2 & Svetlana Vujovic 1,
1Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Serbia, Belgrade, Serbia; 2Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 3Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA; 4Institute of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia; 5Institute of Medical Statistics and Informatics, Belgrade, Serbia.
Hypercortisolism is associated with high prevalence of psychiatric disorders and major depression occurs in 50–60% of patients. According to the available literature it is still unknown if patients with (possible) autonomous cortisol secretion ((P)ACS) carry the risk of depressive disorders. The Beck Depression Inventory II (BDI-II) is a commonly used instrument for detecting and quantifying levels of depression and its validity as a screening instrument is well established. The aim of this study was to screen patients with adrenal incidentalomas (AI) – nonfunctional and the ones with (P)ACS, for presence of depression. The study was conducted in Clinic for endocrinology, diabetes and metabolic diseases, Belgrade, Serbia. The total studied group consisted of 72 patients: 40 AI patients (mean age 56.4±7.3 years, mean body mass index (BMI) 28.9±4.6 kg/m2 and mean adrenal tumor size (ATS) 33.2±9.8 mm) and age matched 32 healthy controls (HC)(mean age 57.6±9.2 years, mean BMI 26.6±4.4 kg/m2). Based on levels of cortisol after 1 mg-dexamethasone suppression test AI patients were divided in two groups: <50 nmol/l, 17 with nonfunctional AI (NAI) and >50 mmol/l, 23 with ((P)ACS). BDI-II screening tool was used to assess presence of depression. The patients with AI had significantly higher BDI-II score when compared with HC: 19-mild vs. 9-minimal depression, P=0.002. In AI group, patients with (P)ACS had significantly higher BDI-II score when compared to NAI: 25-moderate vs. 11-minimal depression. Furthermore, there was a significant positive correlation between the BDI-II score and the levels of midnight cortisol (ρ=0.527, P<0.001), cortisol after 1mg dexamethasone suppression test (ρ=0.594, P<0.001) and the ATS (ρ=0.362, P=0.02). Patients with AI had significantly higher BMI than HC (P=0.037). In multivariate regression analysis with levels of midnight cortisol, BMI and ATS, midnight cortisol was the independent predictor of severe depression (OR 1.029, 95%CI OR 1.01–1.05, P=0.01). Our study shows that patients with (P)ACS exhibit high prevalence of moderate depressive symptoms. The significant and positive correlation of BDI score with ATS, levels of midnight cortisol and levels of cortisol after 1mg dexamethasone suppression test point to cortisol contribution to the etiology of depression. Our results suggest that patients with (P)ACS should be screened for depression and would benefit from integrated care with psychiatric team.
Volume 56
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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