Psychosis due to

Endocrine DISTURBANCES

Abdul,Amani Abesamis, Khrista Joy Ang, Monica Hazel De Leon, Madelle De Leon, Madonna De Villa, Vanessa

Crispina

Esteban, Lloyd Esteban, Lucky Enriquez, Lovely

Cindy Fabunan, Celeste

Sarah Feranculo, Catherine Tuazon, Robert

Group 2

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 nervousnessfatigueinsomniamood labilitydysphoria Speech may be pressuredheightened activity level

a short attention span impaired recent memory an exaggerated startle responseIn severe cases may exhibit visual

hallucinations and delirium.

Differential Diagnosis Panic disordergeneralized anxiety disorderSocial 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

obesity/“buffalo hump” appearance

muscle wasting slow wound healing easy bruising thinning of the skin

abdominal striae osteoporotic bones

diabetes hirsutism, acne, and

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 lability2)greater tendency to feel best in the

morning3)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'sIndex 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 disorderFIGURE 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 York, 1982.)FIGURE

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 V.P. McNamara, M.D.)

Clinical features:

HirsutismObesityMale-pattern alopecia

Acne Irregular menstrual cyclesDepression

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