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Adrenal tumors with mild cortisol excess raise psychiatric disorder risk. A large Swedish study found that adults with mild autonomous cortisol secretion (MACS) were significantly more likely to develop psychiatric disorders — especially substance use disorders — compared to those with non-functioning adrenal tumors. Clinicians are now being urged to routinely screen these patients for mental health conditions.
A large Swedish study has found that adults with mild autonomous cortisol secretion (MACS) — a condition where adrenal tumors produce slightly elevated cortisol — face a substantially higher risk of psychiatric disorders compared to those with non-functioning adrenal tumors (NFATs). The research, published in The Journal of Clinical Endocrinology & Metabolism, analyzed data from 3,195 patients diagnosed with benign adrenal tumors between 2005 and 2018, followed for a median of 4.7 years.
The risk climbed with higher cortisol concentrations after a dexamethasone suppression test, suggesting a dose-response relationship. The association was particularly pronounced in men and in adults aged 65 and older at baseline.
By the Numbers:
Why it matters: These findings suggest that neuropsychiatric conditions may be an underrecognized burden of mild cortisol excess. Clinicians managing patients with adrenal tumors should incorporate routine mental health screening — including mood, anxiety, sleep, and substance use assessments — into standard care.
