Transcript
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