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

Alessandro Prete; Giuliana Zhu; Liam Swan; Onnicha Suntornlohanakul; Mengjie Xu; Ronchi Cristina l.; Derick Yates; Elhassan Yasir S.

doi:10.1530/endoabs.109.P11

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Endocrine Abstracts (2025) 109 P11 | DOI: 10.1530/endoabs.109.P11

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

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

Alessandro Prete ^1,2,3 , Giuliana Zhu ¹ , Liam Swan ¹ , Onnicha Suntornlohanakul ^1,2,4 , Mengjie Xu ^1,2,5 , Cristina l. Ronchi ^1,2 , Derick Yates ⁶ & Yasir S. Elhassan ^1,2

Author affiliations

¹Department of Metabolism and Systems Science, School of Medical Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom; ²Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom; ³NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; ⁴Endocrinology and Metabolism Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand; ⁵Department of Endocrinology, Taihe Hospital, Hubei University of Medicine, Shiyan, China; ⁶Library and Knowledge Service, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom

Introduction: Adrenal hormone excess and malignancy are associated with clinical manifestations which can affect health-related quality of life (HRQoL) and cognition in patients with adrenal tumours. However, this has not been assessed systematically.

Methods: We conducted a systematic review of original research articles published between January 1990 and December 2023 in the MEDLINE, Embase, Cochrane, and CINAHL databases. Abstract screening, full-text review, and data extraction were conducted in parallel by authors working in pairs. Disagreements and data inconsistencies were resolved through consensus. The 2013 CONSORT-PRO extension statement was used for quality assessment.

Results: After screening 17,601 abstracts, 88 studies were included, which reported on 14,161 adults with adrenal tumours: 7102 had primary aldosteronism (PA), 3062 incidentalomas with or without mild autonomous cortisol secretion (MACS), 2287 adrenal Cushing’s syndrome (CS), 1016 phaeochromocytoma (PHAEO), and 694 adrenocortical cancer (ACC). PA was associated with decreased HRQoL with impaired scores in both physical and mental components, as well as an increased prevalence of depression and anxiety, which improved with targeted interventions (adrenalectomy was more effective than mineralocorticoid receptor antagonists). HRQoL was compromised and fragility was more prevalent in patients with non-aldosterone producing adenomas on a spectrum of increased severity across non-functioning tumours, MACS, and CS, and were ameliorated by adrenalectomy. Decreased cognitive function was also observed in MACS and CS prior to treatment. PHAEO presented with impaired HRQoL and numerous cognitive-inhibiting symptoms, with one study showing improvement 3 months after adrenalectomy. Targeted interventions of ACC were associated with treatment-emergent adverse events negatively affecting HRQoL and cognition. Studies were of moderate-to-high quality, with significant variability in the tools employed to assess the outcomes of interest and the use of adrenal tumour-specific tools was limited.

Conclusions: Adrenal tumours and related treatments affect HRQoL and cognition, which has implications for patient management and long-term follow-up.