{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:36:15Z","timestamp":1792802175332,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Adrenal incidentalomas (AIs) are increasingly detected during imaging performed for conditions unrelated to adrenal pathology. Numerous studies have shown that the presence of AI is associated with a higher frequency of hypertension, type 2 diabetes, dyslipidemia, obesity, and osteoporosis. This increased morbidity is mostly related to mild autonomous cortisol secretion, which is the most common hormonal abnormality in these patients. It is well known that glucocorticoid excess affects the hippocampus and prefrontal cortex, brain structures involved in mood regulation and cognitive processes, leading to a wide range of psychiatric symptoms, including depression. While these effects are well documented in patients with Cushing's syndrome, data on mental health changes in patients with AIs remain scarce. Additionally, the few existing studies have several limitations, leaving important clinical questions unanswered. Consequently, the extent to which AIs are associated with impaired mental health and whether patients would benefit from surgical treatment remains unclear. Addressing these challenges is crucial for developing adequate management strategies. This review explores potential psychological and psychiatric implications of AIs. By synthesizing existing literature, we aim to explain the relationship between AIs and mental health disorders, providing a background for future research and clinical practice guidelines.<\/jats:p>","DOI":"10.1093\/ejendo\/lvaf011","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T13:10:01Z","timestamp":1738415401000},"page":"R1-R6","source":"Crossref","is-referenced-by-count":8,"title":["Do adrenal incidentalomas have an impact on mental health? A comprehensive review"],"prefix":"10.1093","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3034-5598","authenticated-orcid":false,"given":"Darko","family":"Kastelan","sequence":"first","affiliation":[{"name":"Department of Endocrinology, University Hospital Centre Zagreb , Kispaticeva 12, 10000 Zagreb ,","place":["Croatia"]},{"name":"School of Medicine, University of Zagreb , Salata 3, 10000 Zagreb ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Dusek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospital Centre Zagreb , Kispaticeva 12, 10000 Zagreb ,","place":["Croatia"]},{"name":"School of Medicine, University of Zagreb , Salata 3, 10000 Zagreb ,","place":["Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,1]]},"reference":[{"issue":"1","key":"2025022114481130900_lvaf011-B1","doi-asserted-by":"publisher","first-page":"G1","DOI":"10.1093\/ejendo\/lvad066","article-title":"European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors","volume":"189","author":"Fassnacht","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"2025022114481130900_lvaf011-B2","doi-asserted-by":"publisher","first-page":"107","DOI":"10.7326\/M18-3630","article-title":"Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess: a systematic review and meta-analysis","volume":"171","author":"Elhassan","year":"2019","journal-title":"Ann Intern Med"},{"issue":"8","key":"2025022114481130900_lvaf011-B3","doi-asserted-by":"publisher","first-page":"533","DOI":"10.7326\/M16-0547","article-title":"Nonfunctional\u201d adrenal tumors and the risk for incident diabetes and cardiovascular outcomes: a cohort study","volume":"165","author":"Lopez","year":"2016","journal-title":"Ann Intern Med"},{"issue":"1","key":"2025022114481130900_lvaf011-B4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1038\/s41371-017-0011-4","article-title":"The presence of nonfunctioning adrenal incidentalomas increases arterial hypertension frequency and severity, and is associated with cortisol levels after dexamethasone suppression test","volume":"32","author":"Arruda","year":"2018","journal-title":"J Hum Hypertens"},{"issue":"4","key":"2025022114481130900_lvaf011-B5","doi-asserted-by":"publisher","first-page":"S88","DOI":"10.1093\/ejendo\/lvad134","article-title":"Comorbidities in mild autonomous cortisol secretion and the effect of treatment: systematic review and meta-analysis","volume":"189","author":"Pelsma","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"2025022114481130900_lvaf011-B6","doi-asserted-by":"publisher","first-page":"325","DOI":"10.7326\/M21-1737","article-title":"Cardiometabolic disease burden and steroid excretion in benign adrenal tumors: a cross-sectional multicenter study","volume":"175","author":"Prete","year":"2022","journal-title":"Ann Intern Med"},{"issue":"4","key":"2025022114481130900_lvaf011-B7","doi-asserted-by":"publisher","first-page":"e973","DOI":"10.1210\/clinem\/dgz284","article-title":"Adrenal incidentalomas are tied to increased risk of diabetes: findings from a prospective study","volume":"105","author":"Reimondo","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"2025022114481130900_lvaf011-B8","doi-asserted-by":"publisher","first-page":"e1750","DOI":"10.1210\/clinem\/dgad765","article-title":"Kidney function in patients with adrenal adenomas: a single-center retrospective cohort study","volume":"109","author":"Rahimi","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"8","key":"2025022114481130900_lvaf011-B9","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1002\/jbmr.398","article-title":"Risk of new vertebral fractures in patients with adrenal incidentaloma with and without subclinical hypercortisolism: a multicenter longitudinal study","volume":"26","author":"Morelli","year":"2011","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2025022114481130900_lvaf011-B10","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1093\/ejendo\/lvad113","article-title":"High prevalence of frailty in patients with adrenal adenomas and adrenocortical hormone excess: a cross-sectional multi-centre study with prospective enrolment","volume":"189","author":"Dogra","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"11","key":"2025022114481130900_lvaf011-B11","doi-asserted-by":"publisher","first-page":"3320","DOI":"10.1210\/clinem\/dgab468","article-title":"Cardiometabolic outcomes and mortality in patients with adrenal adenomas in a population-based setting","volume":"106","author":"Zhang","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"7","key":"2025022114481130900_lvaf011-B12","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/S2213-8587(22)00100-0","article-title":"Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study","volume":"10","author":"Deutschbein","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"7","key":"2025022114481130900_lvaf011-B13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1093\/ejendo\/lvad069","article-title":"Determinants of muscle function and health-related quality of life in patients with endogenous hypercortisolism: a cross-sectional study","volume":"188","author":"Li","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"1","key":"2025022114481130900_lvaf011-B14","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s12020-011-9456-3","article-title":"Health-related quality of life and fatigue in patients with adrenal incidentaloma","volume":"40","author":"Kastelan","year":"2011","journal-title":"Endocrine"},{"issue":"9","key":"2025022114481130900_lvaf011-B15","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1007\/s40618-021-01509-4","article-title":"Depression: another cortisol-related comorbidity in patients with adrenal incidentalomas and (possible) autonomous cortisol secretion","volume":"44","author":"\u0160ojat","year":"2021","journal-title":"J Endocrinol Invest"},{"issue":"4","key":"2025022114481130900_lvaf011-B16","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1093\/ejendo\/lvad135","article-title":"Risk of dementia and psychiatric or sleep disorders after diagnosis of adrenal adenomas: a population-based cohort study","volume":"189","author":"Li","year":"2023","journal-title":"Eur J Endocrinol"},{"key":"2025022114481130900_lvaf011-B17","doi-asserted-by":"publisher","first-page":"1163482","DOI":"10.3389\/fendo.2023.1163482","article-title":"Functional brain alterations in Cushing's syndrome","volume":"14","author":"Papakokkinou","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"4","key":"2025022114481130900_lvaf011-B18","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1093\/ejendo\/lvad008","article-title":"Cushing's syndrome in the elderly: data from the European registry on Cushing's syndrome","volume":"188","author":"Amodru","year":"2023","journal-title":"Eur J Endocrinol"},{"issue":"9","key":"2025022114481130900_lvaf011-B19","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/0006-3223(92)90079-F","article-title":"Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing's syndrome","volume":"32","author":"Starkman","year":"1992","journal-title":"Biol Psychiatry"},{"issue":"9","key":"2025022114481130900_lvaf011-B20","doi-asserted-by":"publisher","first-page":"E1640","DOI":"10.1210\/jc.2012-1945","article-title":"Long-term cognitive impairments and attentional deficits in patients with Cushing's disease and cortisol-producing adrenal adenoma in remission","volume":"97","author":"Ragnarsson","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2025022114481130900_lvaf011-B21","doi-asserted-by":"publisher","first-page":"2699","DOI":"10.1210\/jc.2009-2032","article-title":"Subtle cognitive impairments in patients with long-term cure of Cushing's disease","volume":"95","author":"Tiemensma","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2025022114481130900_lvaf011-B22","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1007\/s10571-018-0625-2","article-title":"Corticosteroid receptors in the brain: transcriptional mechanisms for specificity and context-dependent effects","volume":"39","author":"Meijer","year":"2019","journal-title":"Cell Mol Neurobiol"},{"issue":"3","key":"2025022114481130900_lvaf011-B23","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1210\/edrv.19.3.0331","article-title":"Brain corticosteroid receptor balance in health and disease","volume":"19","author":"De Kloet","year":"1998","journal-title":"Endocr Rev"},{"issue":"1","key":"2025022114481130900_lvaf011-B24","doi-asserted-by":"publisher","first-page":"R1","DOI":"10.1530\/EJE-14-1101","article-title":"Mechanisms in endocrinology: Cushing's syndrome causes irreversible effects on the human brain: a systematic review of structural and functional magnetic resonance imaging studies","volume":"173","author":"Andela","year":"2015","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"2025022114481130900_lvaf011-B25","doi-asserted-by":"publisher","first-page":"459","DOI":"10.3934\/Neuroscience.2020028","article-title":"Stress and serum cortisol levels in major depressive disorder: a cross-sectional study","volume":"7","author":"Bertollo","year":"2020","journal-title":"AIMS Neurosci"},{"issue":"5","key":"2025022114481130900_lvaf011-B26","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1016\/j.cpr.2010.04.010","article-title":"Stress generation in depression: a systematic review of the empirical literature and recommendations for future study","volume":"30","author":"Liu","year":"2010","journal-title":"Clin Psychol Rev"},{"issue":"5","key":"2025022114481130900_lvaf011-B27","doi-asserted-by":"publisher","first-page":"R205","DOI":"10.1530\/EJE-16-0946","article-title":"DIAGNOSIS OF ENDOCRINE DISEASE: differentiation of pathologic\/neoplastic hypercortisolism (Cushing's syndrome) from physiologic\/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing's syndrome)","volume":"176","author":"Findling","year":"2017","journal-title":"Eur J Endocrinol"},{"issue":"21","key":"2025022114481130900_lvaf011-B28","doi-asserted-by":"publisher","first-page":"e1961","DOI":"10.1212\/WNL.0000000000006549","article-title":"Circulating cortisol and cognitive and structural brain measures: the Framingham Heart Study","volume":"91","author":"Echouffo-Tcheugui","year":"2018","journal-title":"Neurology"},{"issue":"7","key":"2025022114481130900_lvaf011-B29","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1001\/archpsyc.64.7.810","article-title":"Associations of salivary cortisol with cognitive function in the Baltimore memory study","volume":"64","author":"Lee","year":"2007","journal-title":"Arch Gen Psychiatry"},{"key":"2025022114481130900_lvaf011-B30","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.maturitas.2022.10.006","article-title":"Adrenal aging and its effects on the stress response and immunosenescence","volume":"168","author":"Stamou","year":"2023","journal-title":"Maturitas"},{"key":"2025022114481130900_lvaf011-B31","doi-asserted-by":"publisher","first-page":"1154112","DOI":"10.3389\/fnagi.2023.1154112","article-title":"Serum cortisol is negatively related to hippocampal volume, brain structure, and memory performance in healthy aging and Alzheimer's disease","volume":"15","author":"Dronse","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"2025022114481130900_lvaf011-B32","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.jsbmb.2014.03.014","article-title":"DHEA and cognitive function in the elderly","volume":"145","author":"Maggio","year":"2015","journal-title":"J Steroid Biochem Mol Biol"},{"issue":"1","key":"2025022114481130900_lvaf011-B33","doi-asserted-by":"publisher","first-page":"24","DOI":"10.2174\/1745017901612010024","article-title":"Dehydroepiandrosterone, its sulfate and cognitive functions","volume":"12","author":"de Menezes","year":"2016","journal-title":"Clin Pract Epidemiol Ment Health"},{"issue":"1","key":"2025022114481130900_lvaf011-B34","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12933-023-01836-1","article-title":"The degree of cortisol secretion is associated with diabetes mellitus and hypertension in patients with nonfunctioning adrenal tumors","volume":"22","author":"Favero","year":"2023","journal-title":"Cardiovasc Diabetol"},{"issue":"12","key":"2025022114481130900_lvaf011-B35","doi-asserted-by":"publisher","first-page":"2929","DOI":"10.1007\/s40618-024-02440-0","article-title":"Cardiometabolic comorbidities and cardiovascular events in \u201cnon-functioning\u201d adrenal incidentalomas: a systematic review and meta-analysis","volume":"47","author":"Favero","year":"2024","journal-title":"J Endocrinol Invest"},{"issue":"10","key":"2025022114481130900_lvaf011-B36","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.3390\/diagnostics12102356","article-title":"Long-term psychosocial consequences of whole-body magnetic resonance imaging and reporting of incidental findings in a population-based cohort study","volume":"12","author":"Korbmacher-B\u00f6ttcher","year":"2022","journal-title":"Diagnostics (Basel)"},{"key":"2025022114481130900_lvaf011-B37","doi-asserted-by":"publisher","first-page":"109451","DOI":"10.1016\/j.ejrad.2020.109451","article-title":"Incidental findings in whole-body MR imaging of a population-based cohort study: frequency, management and psychosocial consequences","volume":"134","author":"Schlett","year":"2021","journal-title":"Eur J Radiol"},{"issue":"4","key":"2025022114481130900_lvaf011-B38","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1017\/S0963180120000304","article-title":"The impact of incidental findings detected during brain imaging on research participants of the Rotterdam study: an interview study","volume":"29","author":"Bomhof","year":"2020","journal-title":"Camb Q Healthc Ethics"},{"issue":"6","key":"2025022114481130900_lvaf011-B39","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1016\/j.surg.2012.08.054","article-title":"Adrenalectomy may improve cardiovascular and metabolic impairment and ameliorate quality of life in patients with adrenal incidentalomas and subclinical Cushing's syndrome","volume":"152","author":"Iacobone","year":"2012","journal-title":"Surgery"},{"issue":"1","key":"2025022114481130900_lvaf011-B40","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s12020-012-9856-z","article-title":"Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass","volume":"44","author":"Muth","year":"2013","journal-title":"Endocrine"},{"issue":"8","key":"2025022114481130900_lvaf011-B41","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1016\/j.eprac.2024.05.002","article-title":"Relationship between dexamethasone suppression test cortisol level &gt;0.9 \u03bcg\/dL and depression and quality of life in adrenal incidentalomas: a single center observational case-control study","volume":"30","author":"G\u00fcne\u015f","year":"2024","journal-title":"Endocr Pract"},{"issue":"1","key":"2025022114481130900_lvaf011-B42","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1210\/clinem\/dgaa695","article-title":"Mental health in patients with adrenal incidentalomas: is there a relation with different degrees of cortisol secretion?","volume":"106","author":"Morelli","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"2025022114481130900_lvaf011-B43","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1210\/clinem\/dgac603","article-title":"Impaired cognitive function in patients with autonomous cortisol secretion in adrenal incidentalomas","volume":"108","author":"Liu","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"2025022114481130900_lvaf011-B44","doi-asserted-by":"publisher","first-page":"129","DOI":"10.3389\/fnins.2015.00129","article-title":"Neuropsychiatric disorders in Cushing's syndrome","volume":"9","author":"Pivonello","year":"2015","journal-title":"Front Neurosci"}],"container-title":["European Journal of Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejendo\/advance-article-pdf\/doi\/10.1093\/ejendo\/lvaf011\/61724234\/lvaf011.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/192\/2\/R1\/61724234\/lvaf011.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejendo\/article-pdf\/192\/2\/R1\/61724234\/lvaf011.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:48:27Z","timestamp":1740149307000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/192\/2\/R1\/7994606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,1]]},"references-count":44,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejendo\/lvaf011","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,2]]},"published":{"date-parts":[[2025,2,1]]}}}