Endocrine Disorders and Psychiatric Manifestations

Abstract

The relationships between endocrine and psychiatric diseases are bidirectional. Most endocrine disorders are associated with psychological disturbances, and, conversely, psychiatric entities induce changes in hormonal activity, as is the case for adrenal and thyroid hormones. In some cases psychiatric manifestations precede organic symptoms of endocrine dysfunction, allowing an early diagnosis. Moreover, biochemical control on endocrine hypo- or hyperfunction is not always associated with normalization of quality of life (QoL), due in part to persistence of psychological problems. Direct effects of hormonal imbalance, insulin resistance, and inflammation on neuronal structures such as the limbic system represent crucial mediators of central nervous system injury leading to mood disturbances and cognitive impairment. Main psychiatric manifestations associated with endocrine diseases are depression, anxiety, mania, and eating disorders. Psychosis and suicidal thoughts may appear in severe cases. Cushing’s disease and thyroid dysfunction states are commonly associated with mental disorders, which in some cases are not reversible even after hormonal imbalance has been corrected, suggesting permanent neuronal damage. Changes in body appearance, such as those occurring in acromegaly, polycystic ovary syndrome, and obesity, play a significant role in the development of psychiatric manifestations. Diseases that affect lifestyle and require chronic self-monitoring such as diabetes and obesity are commonly associated with psychological problems. In general, treatment of endocrine dysfunction improves mood, but sometimes, psychiatric conditions remain requiring specific therapy. Inadequate hormonal treatment may also induce psychiatric symptoms. Coexistence of psychiatric disturbances with endocrine diseases may reduce therapeutic adherence, impair treatment outcomes, and increase healthcare costs. Endocrinologists, internists, primary care doctors, and psychiatrists should be aware of bilateral interactions between psychiatric and endocrine disease to program a multidisciplinary approach so promoting early diagnosis and treatment as well as QoL improvement.