SUN-354 Quality of Life in Patients with Primary Macronodular Adrenal Hyperplasia

Background: The majority of patients with Cushing’s syndrome (CS) have physical and psychological symptoms that may lead to impaired quality of life (QoL). QoL improving with treatment but remaining significantly impaired compared with the general population despite long-term remission. Aim of this study: To demonstrate that patients with PMAH can present cognitive and psychopathological impairment and show the outcomes after treatment. Methods and Material: The following tools were applied in 14 patients with PMAH: Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), Factorial Personality Battery (FPB) and EQ-5D. Results: Eleven patients (78,5%) were females, median age 51 years (40-70) and males median age was 53 years (37-62). According to dexamethasone suppression test (DST), 35,7% were classified as possibly autonomous cortisol secretion (DST 1,8 - 5,0 mcg/dl), and 64,3% were autonomous cortisol secretion (DST > 5,0 mcg/dl). The median BMI was 29,6 kg/m(2) in female and 32,4 kg/m(2) in males. 85,7% presented arterial hypertension. 64,2% had DM or intolerance to glucose and 78,5% had dyslipidemia. Eight patients presented ARMC5 mutation and 2 patients were familial cases, all mutations were in exon 1. Only one patient had a Meningioma. Ten patients responded to MMSE (40% presented low cognitive evaluation). The HADS was answered by 14 patients. In the anxiety scale 71,5% had moderate to severe symptoms and 7,1% had mild symptoms. In the depression scale 57,2% presented moderate to severe symptoms and 21,4% had mild symptoms. The FPB show that the patients had exacerbated characteristics in their personality (57% in the neuroticism factor, 21% in extroversion factor, 43% in the sociability factor, 7% in the realization factor and 14% in the openness factor. The EQ-5D demonstrated that 71,4% measured their health status as moderate or severe. The median quality-adjusted life years (QALY) was 0,363 (range -0,07-0,704). Three patients repeated the analyzes after Sparing Adrenal Surgery. One patient presented normal cortisol secretion and two patients’ latent adrenal insufficiency. Two patients responded to the MMSE, with normalization of their cognition. Two patients had improvement in HADS, mainly on the depression scale. Two patients had passed from severe to mild health status on the EQ-5D, and the median QALY increased to 0,704 in both patients. Discussion: The present study clearly demonstrated reduced quality of life in the patients with PMAH. Despite the small number of patients evaluated after the improvement of hypercortisolism, an improvement in the quality of life was demonstrated in these patients. Conclusion: Adrenal surgery is used to control PMAH hypercortisolism and reduce cardiovascular events, but the patient’s quality of life should also be taken into account when considering treatment options.