Clinical Scorecard: Mental Health and Sleep Issues in Individuals with Nonfunctional Adrenal Tumors
At a Glance
Category
Detail
Condition
Nonfunctional adrenal tumors (NFATs) and associated psychiatric and sleep disorders
Key Mechanisms
Mild abnormal cortisol secretion potentially causing subtle cortisol excess affecting brain function and HPA axis regulation
Target Population
Patients diagnosed with NFATs without hormonal hypersecretion or malignancies
Care Setting
Outpatient and inpatient clinical settings with access to imaging and psychiatric evaluation
Key Highlights
Patients with NFATs have a higher prevalence and incidence of psychiatric and sleep disorders compared to matched controls.
Mild autonomous cortisol secretion (MACS) occurs in 43-45% of adrenal tumors and may contribute to metabolic and mental health disturbances.
Subtle cortisol dysregulation in NFATs is linked to increased risks of cardiometabolic conditions and mental health disorders including depression and anxiety.
Guideline-Based Recommendations
Diagnosis
Identify NFATs via imaging incidentalomas and exclude hormonally active adrenal tumors using clinical and biochemical assessments.
Exclude patients with adrenal hormone excess disorders (e.g., Cushing syndrome, primary aldosteronism, pheochromocytoma) to focus on NFATs.
Use 1-mg dexamethasone suppression test (DST) to differentiate NFATs (≤50 nmol/L cortisol) from MACS (>50 nmol/L cortisol).
Management
Monitor patients with NFATs for psychiatric and sleep disorders given increased risk.
Consider adrenalectomy cautiously; current evidence on reversal of mental health changes post-adrenalectomy is limited.
Address cardiometabolic comorbidities commonly associated with NFATs to reduce overall morbidity.
Monitoring & Follow-up
Longitudinal follow-up for development of psychiatric, sleep, mood, anxiety, stress-related, and psychotic disorders.
Adjust monitoring for socioeconomic factors influencing mental health outcomes.
Regular assessment of cortisol secretion patterns and metabolic parameters.
Risks
Increased risk of psychiatric and sleep disorders in NFAT patients compared to controls (adjusted hazard ratio ~1.92).
Potential progression from NFAT to MACS in up to 31% of cases.
Elevated risk of cardiometabolic diseases and mortality associated with subtle cortisol excess.
Patient & Prescribing Data
Patients with NFATs identified through national registers excluding hormonally active tumors and malignancies.
Hydrocortisone prescription data post-adrenalectomy tracked; however, specific mental health treatment data not detailed.
Clinical Best Practices
Exclude hormonally active adrenal tumors before diagnosing NFAT to ensure accurate risk stratification.
Incorporate psychiatric and sleep disorder screening in routine follow-up of NFAT patients.
Adjust for confounding socioeconomic factors when assessing mental health outcomes in NFAT populations.
