Psychological Burden in Mild Autonomous Cortisol Secretion: A Cross-Sectional Comparative Study

OBJECTIVE: Mild autonomous cortisol secretion (MACS) is characterized by cortisol excess without overt Cushing's syndrome. While metabolic complications are well-documented, the psychological burden remains incompletely understood. This study aimed to assess self-reported depressive and anxiety symptoms and health-related quality of life in MACS patients using validated Turkish instruments and compare findings with Turkish population norms. METHODS: This cross-sectional study included 40 MACS patients (34 women, 6 men; mean age 56.3±9.3 years) from 45 newly diagnosed patients (3 excluded as per exclusion criteria, 2 declined). MACS was diagnosed according to European Society of Endocrinology guidelines. As part of institutional protocol, psychological assessments were routinely performed at diagnosis for all newly diagnosed patients. Assessments included Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Short Form-36 (SF-36) using validated Turkish versions. RESULTS: Mean BDI category score was 1.93±0.80 (minimal to mild depressive symptoms) and mean BAI category score was 2.30±0.82 (mild anxiety symptoms). SF-36 scores were significantly lower than Turkish population norms across all domains except emotional well-being (p < 0.001 for all significant domains except bodily pain, p = 0.012). Subgroup analysis by post-dexamethasone cortisol levels showed no significant differences in psychological parameters. CONCLUSIONS: MACS patients exhibit impaired quality of life across most SF-36 domains compared to Turkish population norms, despite only mild self-reported depressive and anxiety symptoms. Although limited by the absence of a matched control group and potential confounding by metabolic comorbidities, these findings suggest that psychological screening and quality of life assessment may be valuable in MACS evaluation.