Increased Risk of Psychiatric and Sleep Disorders in Nonfunctional Adrenal Tumor Patients
Overview
This large national retrospective study found that individuals with nonfunctional adrenal tumors (NFATs) have a significantly higher prevalence and incidence of psychiatric and sleep disorders compared to matched controls. The increased risk persisted after adjusting for demographic and socioeconomic factors and was consistent across various psychiatric subtypes.
Background
Adrenal tumors are commonly detected incidentally, with most being benign and nonfunctional. However, subtle cortisol secretion abnormalities may occur even in NFATs, potentially impacting metabolic and mental health. While overt cortisol excess in Cushing syndrome is known to cause psychiatric and cognitive impairments, the mental health consequences of NFATs remain underexplored. This study aimed to clarify the association between NFATs and psychiatric and sleep disorders.
Data Highlights
Parameter
NFAT Cases (n=17,561)
Controls (n=122,561)
Odds Ratio (95% CI)
Hazard Ratio (95% CI)
Previous psychiatric/sleep disorders prevalence
Higher
Lower
2.11 (2.03-2.19)
Incidence of psychiatric/sleep disorders during follow-up
Higher
Lower
1.92 (1.83-2.02)
Key Findings
Patients with NFATs had over twice the odds of prior psychiatric and/or sleep disorders compared to controls (adjusted OR 2.06).
During a median 5.4-year follow-up, NFAT patients had nearly double the risk of developing new psychiatric and/or sleep disorders (adjusted HR 1.92).
Increased risks were consistent across psychiatric subtypes including mood, anxiety, stress-related, psychotic, substance abuse, and sleep disorders.
Sensitivity analyses with alternative control groups and longer cancer-free survival periods confirmed the robustness of findings.
Exclusion of hormonally active adrenal tumors ensured focus on NFATs, highlighting subtle cortisol effects on mental health.
Clinical Implications
Clinicians should be aware of the elevated risk of psychiatric and sleep disorders in patients diagnosed with NFATs, even in the absence of overt hormonal activity. Monitoring mental health and sleep quality in this population may facilitate earlier identification and management of these comorbidities. Further research is needed to determine if adrenalectomy or other interventions can mitigate these risks.
Conclusion
Nonfunctional adrenal tumors are associated with a significantly increased risk of psychiatric and sleep disorders, underscoring the need for integrated care approaches addressing mental health in these patients.
References
Johannsson et al. 2024 -- Mental Health and Sleep Issues in Individuals with Nonfunctional Adrenal Tumors
