Psychiatric symptomatology related to endocrine disorders
Psychiatric symptoms are commonly present during the course of endocrine disorders, which complicates diagnostic decisions. Common symptoms across endocrine diagnoses include affective disturbances (e.g. depression, anxiety), cognitive dysfunction, dementia, delirium and psychosis. This article provides a review of the psychiatric morbidity within endocrine disorders. Conditions associated with dysfunction of the pituitary, thyroid, parathyroid, adrenals and gonads are reviewed, as well as diabetes mellitus.
Disorders of the thyroid
Hypothyroidism is the most common pathological hormone deficiency and can be classified on the basis of its time of onset (congenital or acquired), level of endocrine dysfunction responsible (primary or secondary) and severity (overt or mild). Overt hypothyroidism has been associated with symptoms such as energy loss, weight gain, slowed reflexes, cold intolerance, weight gain, constipation, dry skin, bradycardia, hoarseness and slowed cognitive processing. However, as many as 60–70% of newly diagnosed patients do not experience significant symptomatology (Ladenson et al., 1997). Those with mild hypothyroidism also often do not have symptoms.
Psychiatric and neurological manifestations can include depression (Ladenson et al., 1997), anxiety (Sait Gonen et al., 2004), psychosis (Alp et al., 2004), ataxia (Price & Netsky, 1966), seizures (Woods & Holmes, 1977) and coma (Nicoloff & LoPresti, 1993). Overt hypothyroidism commonly manifests itself with cognitive impairment and depression. Psychiatric symptoms progress in a gradual course of neurocognitive deficits beginning with mental slowing followed by cognitive disturbances (e.g. short-term memory problems) and depression.