Psychiatric and Sleep Disorders in Patients With Nonfunctional Adrenal Tumors

An increase of psychiatric and sleep-related disorders could be hypothesized due to mild abnormal cortisol secretion in patients with nonfunctional adrenal tumors (NFATs).

To investigate the risk of psychiatric and sleep disorders in individuals with NFATs.

A national retrospective register-based study was conducted on patients diagnosed with NFATs 2005-2019 and controls, followed until death or 2019. Individuals diagnosed with adrenal hormone excess or previous malignancies were excluded. Follow-up commenced after 90 days of cancer-free survival following the NFAT diagnosis. Sensitivity analyses were performed on patients with acute appendicitis and gallbladder/biliary tract/pancreas disorders, and 180- and 365-day cancer-free survival. The primary study outcomes were the prevalence and incidence of psychiatric and/or sleep disorders after adjusting for sex, age, and socioeconomic factors. Secondary outcomes were psychiatric, sleep, substance abuse, mood, anxiety and stress-related, and psychotic disorders.

In total, 17 561 cases (60% women, median [IQR] age 65 [56-73] years) and 122 561 controls were included. Previous psychiatric and/or sleep disorders were more prevalent in patients diagnosed with NFATs compared to controls (odds ratio [OR] 2.11; 95% CI 2.03-2.19; adjusted OR 2.06, 95% CI 1.98-2.14). During the follow-up period (5.4 years [IQR 2.4-8.6]), the incidence of psychiatric and/or sleep disorders was higher in patients with NFATs than in controls (hazard ratio [HR] 1.92; 95% CI 1.83-2.02; adjusted HR 1.92; 95% CI 1.82-2.01). Similar increases were found in all secondary outcomes as well as in the same direction in all sensitivity analyses.

NFAT was associated with an increased risk of psychiatric and sleep disorders.