Psychosis due to Endocrine DISTURBANCES

Group 2
 Abdul,Amani  Abesamis, Khrista Joy  Ang, Monica Hazel  De Leon, Madelle  De Leon, Madonna  De Villa, Vanessa  Esteban, Lloyd  Esteban, Lucky  Enriquez, Lovely

Crispina

Cindy  Fabunan, Celeste Sarah  Feranculo, Catherine  Tuazon, Robert

Hyperthyroidism
Grave’s Disease hyperfunctioning solitary thyroid adenomas thyroiditis use of exogenous thyroid hormone TSH-producing pituitary adenoma pituitary resistance of suppression of TSH

secretion by thyroid hormone

Grave's disease (exophthalmic goiter)

Features

Psychiatric features include nervousness fatigue insomnia mood lability dysphoria Speech may be pressured heightened activity level
a short attention span  impaired recent memory  an exaggerated startle response In severe cases may exhibit visual

hallucinations and delirium.

Differential Diagnosis Panic disorder generalized anxiety disorder Social and specific phobias

Treatments for Graves' disease  antithyroid drugs  radioactive iodine (RAI)  surgical thyroidectomy

HYPOTHYROIDISM
• result from inadequate synthesis of

thyroid hormone • categorized as:
– overt – subclinical

Differential Diagnosis
 Depression
 Lethargy  Poor concentration  Impaired memory  Apathy

Differential Diagnosis
 Bipolar patients with depression  Certain medications
 E.g. barbiturates

Signs and symptoms:

Psychiatric symptoms:
 depressed mood  apathy  impaired memory and concentration  long response latency

Treatment
• Current preparations of

exogenous thyroid hormone include:
 levothyroxine (Levothroid, Lexoxyl)  synthetic T 4  liothyronine (Cytomel)  synthetic T3; liotrix (Thyrolar)  mixed synthetic T4 and T3  desiccated thyroid (Armour)

Hypercortisolism
 Cushing's syndrome
 adrenocortical hyperfunction  pituitary adenoma  ACTH dependent  non-ACTH-dependent

Hypercortisolism

Hypercortisolism
Diagnosis and Clinical Features
 “moonfacies”  truncal  diabetes  hirsutism, acne, and

    

obesity/“buffalo hump” appearance muscle wasting slow wound healing easy bruising thinning of the skin →abdominal striae osteoporotic bones

amenorrhea  hyperpigmentation  hypertension  sodium retention, potassium loss, metabolic alkalosis, and edema

Hypercortisolism
Diagnosis and Clinical Features  fatigue  depressed mood (moderate or severe depression)

Hypercortisolism
Diagnosis and Clinical Features  social withdrawal  paranoia, hallucinations, and depersonalization  cognitive changes (deficits in concentration and memory)

Differences of Cushing’s syndrome

from Major depressive disorder
1)greater irritability and mood lability 2)greater tendency to feel best in the

morning 3)less guilt and hopelessness compared to patients with major depression  

Treatment and Course
• Treatment of pituitary ACTH-producing tumors  surgical resection  pituitary irradiation • Adrenal adenomas and carcinomas  removed surgically  chemotherapy is instituted in case of carcinoma • Medications that antagonize cortisol production  metyrapone or mitotane [tysobren] • Medications that suppress ACTH  serotonin antagonists (eg. cyproheptadine [Periactin]) •

Prednisone treatment, lithium and neuroleptic medications  help prevent the development of manic or psychotic symptoms

Adrenocortical Insufficiency
 inadequate production of three major steroid hormones

Primary adrenal insufficiency
 adrenal hypofunction

Secondary adrenal insufficiency
 results from deficient ACTH secretion

Tertiary adrenal insufficiency
 refers to deficient hypothalamic secretion of CRH

 Symptoms of adrenal insufficiency  include weakness, hypoglycemia, hyponatremia,

hyperkalemia, nausea, diarrhea, fever, symptoms, including fatigability, salt craving, weight loss, vitiligo, nausea, hyperpigmetntation, loss of ACTH stimulation test
 symptoms of chronic adrenal insufficiency

overlap those of depression

Pathology and Laboratory Examination

 Laboratory findings:
 low serum concentrations of sodium  high concentrations of potassium  low or normal plasma cortisol concentrations

Treatment  Acute adrenal insufficiency  requires immediate treatment with intravenous hydrocortisone in addition to fluid replacement with saline solution and potassium supplementation
 Primary adrenal insufficiency  Mineralocorticoid

e.g., fludrocortisone [Florinef]
 Chronic adrenal insufficiency  prednisone or hydrocortisone is administered

orally as maintenance treat

 regulates the serum calcium through

its effect on the bones, gut and the kidney.

 Dysfunction of parathyroid gland leads

to abnormal regulation of the calcium metabolism.

 Hypercalcemia results to:
   

delirium personality changes apathy cognitive impairments

 Hypocalcemia
 personality changes and

delirium
 psychiatric symptoms without

the characteristic tetany of hypocalcemia is observed if calcium gradually decreases.

PROLACTIN
 milk production  maternal behavior  inhibited by dopamine(PIF)

Factors that increases the prolactin concentration • Drugs: methyldopa and

• • • • •

reserpine oral contraceptive estrogen serotonergic antidepressant propranolol hypothyroidism

Hyperprolactinemia
 higher level of depression  stress intolerance  increased irritability  hostility

Gigantism

FIGURE 25.6-7 A case of simple (primary) gigantism. The Austrian giant, Winkelmeyer, 7 ft. 6 in. tall. (Reprinted with permission from Douthwaite AH, editor: French's Index of Differential Diagnosis, ed 7. Williams & Wilkins, Baltimore, 1954.)

Acromegaly
 pituitary tumor  The nose, jaw, tongue, and

soft tissues of the hands and feet become enlarged, as do the heart, liver, and kidneys.

 Adjustment disorder

FIGURE 25.6-6 A. Before onset of acromegaly. B. Acromegaly: enlargement of the mandible, nose, and lips is obvious. (Reprinted with permission from Spillane JD, Spillane JA: An Atlas of Clinical Neurology, ed 3. Oxford University Press, New

ANDROGEN INSENSITIVITY SYNDROME
 testicular feminization  Complete androgen insensitivity
 Body fat and hair distribution are typically

female, and breasts develop after puberty.

FIGURE 25.6-8 A phenotypic female with abdominal testes and an XY chromosomal karyotype. Note the excellent breast development and the absence of pubic hair. A normal blind vagina was present without clitoral enlargement. (Courtesy of R.B. Greenblatt, M.D., and

Clinical features:
 Hirsutism  Obesity  Male-pattern alopecia

 Acne  Irregular menstrual cycles  Depression

Laboratory Findings
 Ultrasound: enlarged ovaries with

multiple cystic follicles

 Risk for:
 Endometrial hyperplasia and carcinoma.  Type II diabetes

secondary to insulin resistance associated with hyperandrogenism

 Association between depression and

hyperandrogenism in women

Treatment
 antiestrogens :
 clomiphene (Clomid)  Gonadotropins  laparoscopic surgery  low-dose oral contraceptives

 Weight reduction  spironolactone

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