Non-Functional Adrenal Tumors Linked to Increased Risk of sleep and Psychiatric Disorders
A new study reveals a meaningful association between non-functional adrenal tumors (NFATs) and a heightened risk of both sleep-related and psychiatric disorders, potentially impacting a substantial number of patients. Published in The Journal of Clinical Endocrinology & metabolism,the research underscores the importance of monitoring mental and sleep health in individuals diagnosed with these typically benign growths.
Researchers conducted a comprehensive population-based retrospective cohort study utilizing multiple Swedish national registers and ICD-10 codes spanning from 2005 to 2019. The study aimed to determine the prevalence and incidence of sleep and psychiatric disorders among patients with NFATs, carefully adjusting for factors like sex, age, and socioeconomic status. Participants were followed until 2019 or death, with a 90-day waiting period after a cancer-free diagnosis to ensure accurate data. Individuals with pre-existing adrenal hormone excess or a history of malignancies were excluded from the analysis.
The study encompassed a large cohort of 17,561 patients diagnosed with NFATs – with a median age of 65 and a majority (60.4%) being women – alongside a control group of 122,561 individuals. Notably, patients with nfats exhibited a higher prevalence of pre-existing conditions like diabetes (17.0%), cerebrovascular diseases (14.3%), and chronic obstructive pulmonary disease (COPD; 9.7%) compared to the control group (8.1%, 4.8%, and 2.7% respectively).
The findings revealed a striking difference in the rates of sleep and psychiatric disorders. Patients with NFATs were more than twice as likely to have a history of these conditions compared to the control group (25.2% vs 13.8%; adjusted odds ratio [aOR] 2.06; 95% CI, 1.98-2.14). Furthermore, the incidence of developing these disorders during a median follow-up period of 5.3 years was also significantly elevated in the NFAT group (adjusted hazard ratio [aHR] 1.92; 95% CI, 1.82-2.01).
Digging deeper, the study found that the increased risk was consistent across genders, with women and men with NFATs showing similar prevalence of pre-existing sleep and psychiatric disorders (aOR, 2.08 vs 2.04). Though, a slightly higher risk was observed in patients under 65 years of age at the time of diagnosis (aOR, 2.22 vs 1.88 for those 65 and older).
This age-related difference persisted during follow-up, with younger patients experiencing a greater risk of developing sleep and/or psychiatric disorders (aHR, 2.08 vs 1.78). Women with NFATs also demonstrated a higher risk during follow-up compared to men (aHR, 2.01 vs 1.77).
Interestingly, even among the 4.7% of NFAT patients who underwent an adrenalectomy within the first year of diagnosis, the elevated risk for sleep and/or psychiatric disorders remained significant (aHR, 1.93). While the risk for anxiety and general psychiatric disorders was somewhat reduced (aHR, 1.66 vs 1.76), the risk for sleep substance abuse, mood disorders, and psychotic disorders remained unchanged.
The researchers acknowledge several limitations to the study, including the lack of direct cortisol measurements and the inability to distinguish between nfats and cases of mild autonomous cortisol secretion. A systematic assessment of comorbidities like diabetes, COPD, and ischemic heart disease was also lacking, and direct comparison with similar studies proved unachievable. A visual representation of the hazard ratios for different age and gender groups would be beneficial here.
“NFAT was associated with an increased risk of psychiatric and sleep disorders,” the investigators concluded. “Individuals with NFATs younger than 65 years of age demonstrate a greater risk.” They hypothesize that a subtle increase in cortisol secretion may be a contributing factor,but emphasize the need for further research to confirm this proposition. This study highlights the importance of a holistic approach to the care of patients with NFATs, extending beyond the tumor itself to encompass mental and sleep health.
