Impact of diagnosis and targeted interventions on the quality of life and neuropsychiatric outcomes of patients with adrenal tumours: a systematic review.

Abstract

Objective: To systematically evaluate the impact of adrenal tumour diagnosis and targeted interventions on health-related quality of life (HRQoL) and neuropsychiatric outcomes across tumour subtypes.

Design: Systematic review.

Methods: A literature search of MEDLINE, Embase, Cochrane Library, and CINAHL (January 1990-March 2026) identified studies reporting HRQoL and neuropsychiatric outcomes in adults with adrenal tumours, including non-functioning adrenal tumours (NFAT), mild autonomous cortisol secretion (MACS), adrenal Cushing's syndrome (CS), primary aldosteronism (PA), phaeochromocytoma/paraganglioma (PPGL), and adrenocortical carcinoma (ACC). Study quality was assessed using CONSORT-PRO and Newcastle-Ottawa criteria. Due to methodological heterogeneity, findings were synthesized narratively.

Results: A total of 117 studies involving 35 361 patients were included. CONSORT-PRO quality was good but heterogeneous, whereas observational study quality was mostly moderate or low. Across tumour subtypes, adrenal tumours were consistently associated with impaired HRQoL and neuropsychiatric outcomes. A gradient of burden was evident, with mild impairment in NFAT, intermediate impairment in MACS and PA, and the most pronounced and persistent deficits in adrenal CS, PPGL, and ACC. Targeted interventions were often associated with improved patient-reported outcomes, though the magnitude and consistency of benefit varied across tumour subtypes and study design. Recovery was frequently incomplete. Most studies relied on generic HRQoL instruments, and no disease-specific neuropsychiatric tools were identified.

Conclusions: Adrenal tumours are associated with substantial and often persistent impairment in patient well-being across tumour subtypes. Although treatment generally improves outcomes, residual symptoms are common, underscoring the need for long-term, patient-centred care and for the development of adrenal tumour-specific patient-reported outcome measures.