Mild Autonomous Cortisol Secretion Linked to Psychiatric Morbidity in Adrenal Tumor Cohort

A population-based retrospective cohort study in Stockholm, Sweden, examined psychiatric morbidity in 3,195 patients with a first benign adrenal tumor diagnosis during 2005–2018 and an available 1-mg dexamethasone suppression test (DST). Researchers classified 1,216 patients as having mild autonomous cortisol secretion (MACS; post-DST cortisol >50 nmol/L) and 1,979 as having non-functional adrenal tumors (≤50 nmol/L). Median age was 64 years, and 58.9% were women. Analyses of psychiatric diagnoses and dispensed psychotropic medications used register and laboratory data, adjusting for age, sex, and socioeconomic status.

MACS was associated with greater odds of prevalent psychiatric disorders (adjusted odds ratio, 1.35; 95% CI, 1.11–1.64). Over a median 4.7 years, the adjusted hazard ratio for incident psychiatric disorders was 1.79 (95% CI, 1.43–2.23). Associations were reported for anxiety, mood, and substance use disorders, with hazard ratios ranging from 1.41 to 2.50. After correction for multiple comparisons, only overall psychiatric disorders and substance use disorders remained statistically significant.

The findings support considering psychiatric history and symptoms when assessing patients with adrenal tumors. However, this observational study cannot establish that cortisol autonomy causes psychiatric illness or that treating MACS improves psychiatric outcomes. This report is based on the abstract; full-text methods and absolute event rates were not available.