Can an adrenal nodule cause mood disorders and erectile dysfunction?

Can Adrenal Nodules Cause Mood Disorders and Erectile Dysfunction?

Yes, adrenal nodules can cause mood disorders and erectile dysfunction, particularly when they secrete excess hormones that disrupt the hypothalamic-pituitary-gonadal axis.

Pathophysiological Mechanisms

• Adrenal nodules that produce excess cortisol (Cushing's syndrome) can lead to hypothalamic-pituitary axis disruption, causing hypogonadotropic hypogonadism in men, which directly contributes to erectile dysfunction 1
• Hormone-secreting adrenal tumors can affect the normal balance of sex hormones, leading to low testosterone levels in men, which is a well-established cause of erectile dysfunction 1
• In ACTH-independent Cushing's syndrome (caused by adrenal nodules), ACTH levels are low or undetectable, while cortisol levels remain elevated, creating hormonal imbalances that affect sexual function 2
• Excess cortisol from adrenal nodules can lead to increased sex hormone-binding globulin (SHBG), which reduces free testosterone availability, further contributing to erectile dysfunction 1

Clinical Presentation

• Sexual symptoms associated with hormonal imbalances from adrenal disorders include:
  • Reduced libido 1
  • Erectile dysfunction 1
  • Decreased spontaneous/morning erections 1
• Psychological symptoms that may manifest include:
  • Low mood/mood deflection 1
  • Decreased motivation 1
  • Fatigue 1
• Physical symptoms that may accompany these issues:
  • Decreased energy 1
  • Decreased physical strength/function/activity 1

Diagnostic Approach

• All patients with adrenal tumors should undergo comprehensive hormonal evaluation, including cortisol, aldosterone, and catecholamine testing 3
• Cortisol secretion assessment should include a 1 mg overnight dexamethasone suppression test as the preferred screening test 3
• Plasma ACTH levels should be measured as part of the cortisol secretion assessment to determine if Cushing's syndrome is ACTH-dependent or ACTH-independent 3, 2
• For patients with suspected hormone-secreting adrenal nodules, imaging studies such as non-contrast CT should be used to confirm adrenal pathology 4
• Morning (08:00-09:00h) plasma ACTH measurement is optimal for initial assessment of pituitary-adrenal axis function 2

Relationship Between Adrenal Disorders and Sexual Function

• Hormonal therapy and adrenal disorders can contribute to sexual problems, as can depression and anxiety, which are common in patients with endocrine disorders 1
• In men with advanced endocrine disease, low testosterone levels can result from hypogonadotropic hypogonadism, with an additional contribution from increased peripheral conversion of androgens to estrogen 1
• Erectile dysfunction is highly prevalent in men with endocrine disorders and has been associated with a variety of hormonal imbalances including those involving the adrenal glands 5
• Sexual dysfunction is common in adrenal insufficiency patients (41% of women and 59% of men) and is likely explained by multiple factors 6

Management Considerations

• For hormone-secreting adrenal nodules causing significant clinical symptoms, adrenalectomy should be considered according to guidelines 4
• For ACTH-independent Cushing's syndrome from adrenal adenoma, laparoscopic adrenalectomy is recommended 2
• Patients should be informed that hormonal regulators used to treat certain conditions may impair fertility and sexual function 1
• Treatment of erectile dysfunction in patients with endocrine disorders should address the underlying hormonal imbalance rather than just treating symptoms 7

Important Caveats

• Sexual dysfunction is often not discussed with patients despite its significant negative impact on quality of life 1
• Radiological appearance cannot reliably predict hormone secretion status of adrenal nodules, making hormonal evaluation essential 3
• Erectile dysfunction may have multiple contributing factors beyond hormonal, including psychogenic causes, medications (e.g., spironolactone or beta-blockers), and autonomic dysfunction 1, 8
• The differential diagnosis of sexual dysfunction should include psychogenic causes, medication effects, hypogonadism, and autonomic dysfunction 1

By addressing the underlying adrenal disorder and normalizing hormone levels, both mood disorders and erectile dysfunction can often be improved in patients with hormone-secreting adrenal nodules.