Taiwan population study finds association between ADHD and adrenal gland dysfunction

Cortisol is a steroid hormone produced by the adrenal glands situated above the kidneys. Its release is boosted by low blood sugar, which it counteracts, and also in response to stress.

Previous studies on children with ADHD have pointed to lower basal cortisol concentrations in the morning and a significantly lower incidence of typical diurnal fluctuation in cortisol levels.

To better assess the comorbidity of ADHD and adrenal gland disorders, a Taiwan research team affiliated with Chang Gung University College of Medicine used the National Health Insurance database to conduct a nationwide population study. Taiwan has a single-payer national health insurance system that encompasses almost the entire population, and its extensive database facilitates such studies.

Looking at the thirteen years from 1999 through 2011, the team identified 75,247 youths (manage ten years) newly diagnosed with ADHD and matched them by age and sex to another 75, 247 youths not diagnosed with ADHD.

To guard against confounding variables, they also identified psychiatric conditions that are comorbid with ADHD, including oppositional defiant disorder, conduct disorder, autism spectrum disorder, tic disorder, and intellectual disability.

After adjusting for age, sex, and psychiatric comorbidities, youths with ADHD were still 2.4 times more likely to have adrenal gland abnormalities than their normally developing peers. To place this in context, adrenal gland dysfunctions are very uncommon, in this instance occurring in roughly one in a thousand controls, and two in a thousand youths with ADHD.

The team also explored whether the two ADHD medications approved for use in Taiwan had any effect on the outcome. Methylphenidate, a stimulant, is the preferred treatment, with atomoxetine, a non-stimulant, used as an alternative where methylphenidate is inadvisable or found to be suboptimal. Neither methylphenidate nor atomoxetine had any significant effect on the risk of adrenal gland dysfunction.

The authors concluded, “Patients with ADHD had greater comorbid rates with adrenal gland dysfunction than the control subjects. Nevertheless, receiving pharmacotherapy (MPH or ATX) did not significantly influence the risk of developing adrenal gland dysfunction among ADHD patients. Therefore, continuous efforts are needed to promote public awareness of potential adrenal gland dysfunction among ADHD patients.”

Pin-Han Peng, Meng-Yun Tsai, Sheng-Yu Lee, Po-Cheng Liao, Yu-ChiauShyu, and Liang-Jen Wang, “Attention-Deficit/HyperactivityDisorder, Its Pharmacotherapy, and Adrenal Gland Dysfunction: A NationwidePopulation-Based Study in Taiwan,” International Journal of EnvironmentalResearch and Public Health(2020),17(10), 3709,https://doi.org/10.3390/ijerph17103709.