The Journal of Clinical Endocrinology & Metabolism, 2021, Vol. 106, No. 6, e2423–e2433 doi:10.1210/clinem/dgab099 Clinical Research Article ISSN Print 0021-972X ISSN Online 1945-7197 Printed in USA https://academic.oup.com/jcem e2423 © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Clinical Research Article Autonomous Cortisol Secretion Infuences Psychopathological Symptoms in Patients With Primary Aldosteronism Pauline Gendreitzig, 1,2 Heike E. Künzel, 3 Christian Adolf, 3 Laura Handgriff, 3 Lisa Müller, 3 Finn Holler, 3 Lisa Sturm, 3 Daniel A. Heinrich, 3 Martin Reincke, 3 and Marcus Quinkler 1 1 Endokrinologie in Charlottenburg, Endokrinologie Praxis am Stuttgarter Platz, Berlin, Germany; 2 Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Endocrinology and Metabolism, 10117 Berlin, Germany; and 3 Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, 80336 München, Germany ORCiD numbers: 0000-0002-9206-0953 (C. Adolf); 0000-0002-9817-9875 (M. Reincke); 0000-0003-4028-1671 (M. Quinkler). Abbreviations: ACS, autonomous cortisol cosecretion; ADX, unilateral adrenalectomy; ARR, aldosterone to renin ratio; BAS, bilateral aldosterone secretion; BP, blood pressure; DST, dexamethasone suppression test; GAD-7, 7-item Generalized Anxiety Disorder Scale; LNSC, late-night salivary cortisol; MR, mineralocorticoid receptor; MRA, mineralocorticoid receptor antagonist; PA, primary aldosteronism; PHQD, Patient Health Questionnaire; QoL, quality of life; SF-12, 12-item Short-Form Health Survey; UAS, unilateral aldosterone secretion; UFC, urinary free cortisol Received: 9 January 2021; Editorial Decision: 10 February 2021; First Published Online: 17 February 2021; Corrected and Typeset: 17 April 2021. Abstract Context: Primary aldosteronism (PA) is associated with impaired quality of life (QoL). Autonomous cortisol cosecretion (ACS) is a relevant phenotype of PA, which could contribute to depression and anxiety disorders. This has not been investigated so far. Objective: To evaluate the prevalence of depression and anxiety in PA patients according to ACS. Methods: We performed testing for hypercortisolism and evaluated anxiety, depression and QoL by self-rating questionnaires in newly diagnosed PA patients of the German Conn’s Registry; 298 patients were reevaluated at follow-up. Results: In the overall cohort, scores for anxiety (P < .001), depression (P < .001), and QoL (mental P = .021; physical P = .015) improved signifcantly at follow-up. This improvement was seen in both subgroups of patients with and without ACS, with the exception of the mental subscore in no-ACS patients. Analysis for sex differences showed that anxiety decreased signifcantly in females with ACS and no-ACS, whereas males with no-ACS failed to improve. Depression improved signifcantly in males and females with ACS (P = .004, P = 0.011 respectively), but not in those with no-ACS. Physical subscore of QoL Downloaded from https://academic.oup.com/jcem/article/106/6/e2423/6141462 by guest on 10 June 2022