TOPLINE:

Patients with non-functional adrenal tumours had a notably higher prevalence of psychiatric and/or sleep disorders at baseline and were also more likely to develop such issues than control individuals. The risk for incident psychiatric and/or sleep disorders was higher in women and those younger than 65 years.

METHODOLOGY:

• Researchers in Sweden conducted a population-based retrospective cohort study using data from national registers to examine the risk for psychiatric and/or sleep disorders in patients with non-functional adrenal tumours.
• They compared 17,651 patients (median age, 65 years; 60.4% women) diagnosed with non-functional adrenal tumours from 2005 to 2019 with 122,561 control individuals matched on the basis of age, sex, and municipality.
• The median follow-up duration was 5.3 years; follow-up began 90 days after diagnosis, providing the patient remained free of cancer.
• The primary outcome was the occurrence of psychiatric and/or sleep disorders, and secondary outcomes included substance abuse, mood, anxiety and stress-related, and psychotic disorders.

TAKEAWAY:

• At baseline, patients with non-functional adrenal tumours had a higher prevalence of psychiatric and/or sleep disorders than control individuals (adjusted odds ratio, 2.06; 95% CI, 1.98-2.14); they also showed a higher prevalence across all secondary outcomes except psychotic disorders.
• During follow-up, the risk for incident psychiatric and/or sleep disorders was higher in patients with non-functional adrenal tumours than in control individuals (adjusted hazard ratio, 1.92; 95% CI, 1.82-2.01); risks were elevated for all secondary outcomes except psychotic disorders.
• The risk for incident psychiatric and/or sleep disorders was higher in women than in men and in patients younger than 65 years than in those aged 65 years or older.
• The risk for psychiatric and/or sleep disorders remained elevated even after adrenalectomy.

IN PRACTICE:

"Individuals with NFATs [non-functional adrenal tumours] younger than 65 years of age demonstrate a greater risk. A subtle increase in cortisol secretion may be responsible; however, further empirical research is required to substantiate this proposition," the authors wrote.

SOURCE:

This study was led by Hadis Mirzaei, MD, MSc, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. It was published online on September 19, 2025, in The Journal of Clinical Endocrinology & Metabolism.

LIMITATIONS:

This study was limited by the lack of cortisol measurements and the absence of a specific diagnostic code to distinguish mild autonomous cortisol secretion from non-functional adrenal tumours. Moreover, this study did not systematically assess several comorbidities and treatments, such as diabetes, chronic obstructive pulmonary disease, ischaemic heart disease, alcohol use, and hormone therapies.

DISCLOSURES:

This study was supported by grants from the Stockholm Läns Landsting and Karolinska Institutet. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.