Review articlePsychiatric aspects of endocrine disorders in women
Section snippets
Hypothalamic-pituitary disorders
The anterior pituitary gland regulates endocrine organs by integrating signals from the brain, usually by way of releasing hormones from the hypothalamus, and feedback effects of peripheral hormones, to stimulate the release of hormones by specific endocrine glands by way of various stimulating hormones. The hormones secreted by the anterior pituitary gland include thyroid stimulating hormone (thyrotropin; TSH), adrenocorticotropic hormone (ACTH), growth hormone (GH), prolactin (PRL), and the
Hypothalamic–pituitary–thyroid axis disorders
Thyroid hormones are important regulators of body metabolism and play an important role in protein synthesis and oxygen consumption in most of the organs and tissues of the body. There are two main thyroid hormones, thyroxine (T4) and triiodothyronine (T3). T4 is the major hormone secreted by the thyroid gland, whereas T3 is derived primarily from the extrathyroidal conversion of T4 to T3. A minor amount of circulating T3 is directly synthesized by the thyroid gland. T3 then acts at the T3
Hypothalamic–pituitary–adrenal axis disorders
The adrenal axis is the prototypical stress responsive axis. The adrenal cortex produces glucocorticoids, mineralocorticoids, particularly aldosterone, and the androgens. The glucocorticoids, including cortisol, have broad metabolic effects on glucose metabolism, lipolysis, inflammation, and immune responses. The mineralocorticoids, particularly aldosterone, affect sodium and water retention. Isolated hypersecretion of aldosterone is extremely rare but, when it occurs, is more common in women
Glucocorticoid disorders
Cushing's syndrome results from excessive and chronic cortisol secretion, which may be ACTH-dependent or independent of ACTH, such as in a cortisol-secreting tumor. There have been various descriptions of the psychiatric sequelae of hypercortisolemia in Cushing's syndrome. The commonest symptoms reported are fatigue, irritability, memory difficulties, truncal weight gain, depressed mood, sleep disorders, difficulty concentrating, sexual dysfunction, anxiety, and mood lability [12], [13].
Diabetes mellitus
Diabetes mellitus is a common endocrine disorder that leads to substantial disability in the United States, particularly among people over 45 years of age. Type I diabetes resulting from the presumed autoimmune destruction of pancreatic beta cells results in hypoglycemia. Type II diabetes is characterized by hyperglycemia related to insulin resistance in peripheral cells. Management of diabetes requires lifelong monitoring of blood sugar, specific dietary constraints, a good health and exercise
Parathyroid disorders
Hypercalcemia and hypocalcemia may present with psychiatric symptoms. Calcium metabolism is under the regulation of parathyroid hormone, which is a peptide hormone, which controls minute-to-minute levels of ionized calcium in the blood and extracellular fluids. Parathyroid hormone is secreted by the parathyroid gland in response to a decrease in serum calcium levels. Hypocalcemia is relatively uncommon and presents with symptoms of neuromuscular irritability, paresthesias, tingling of the
Summary
Endocrine disorders are associated with significant psychiatric morbidity. Psychiatric symptoms may manifest as discreet psychiatric syndromes or, more commonly, with a heterogenous group of nonspecific symptoms. Research is needed to understand the relations between hormone excess or deficiency and alterations of mood, cognition, and perception. It is important for clinicians to carefully screen for psychiatric morbidity in patients who present with endocrine disorders. Moreover, patients who
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