Psychiatric and Sleep disorders in Patients with Non-Functional Adrenal Tumors.

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

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

Methods: A national retrospective register-based study was conducted on patients diagnosed with NFATs 2005-2019 and controls, followed-up 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.

Results: 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.

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