Losing Their Minds

There is apparently a relation between Addison's disease and a patient's mental state. Here's what we have found:

Introduction

This journal is about the link between Addison’s
disease and psychiatric problems. This link is not commonly appreciated but several literatures indicate that those suffering from Addison’s disease also have disturbances in mood, motivation and behaviour. Thus, psychiatric problems may be one of the diagnostic tools for Addison’s disease and doctors should be careful to make sure that they are on watch since it is a possible fatal disease.
This journal analysed several cases in the 1940s to 1960s which noticed the connection between psychiatric problems and Addison’s .However, in the more recent studies, there has been almost no mention of their link. This resulted in the lack of awareness that Addison’s disease may come with psychiatric symptoms.

Techniques/Case Study

To see the development of Addison’s with a person who is also suffering some psychiatric symptoms, a patient was followed and accessed by the group, through her admittance in the hospital and two months after her discharge.
The patient had no prior history of psychiatric problems but she was referred to the emergency services for “agitation, aggression, disinhibition, and delusions that her husband was pregnant, stealing money, and committing adultery” and suffered from visual/auditory hallucinations. The patient was diagnosed with underlying Addison’s disease.
However, she had endocrine abnormalities, such as “low aldosterone levels” and an almost “undetectable” serum cortisol level. She was  thought to be suffering from an Addisonian crisis and had to take hydrocortisone and fludcortisone which returned her vital signs to normal. After 10 days, she was discharged and had to continue taking  hydrocortisone, fludrocortisone, and -thyroxine.
Two months later, she was well, physically and mentally.


Results

An Addisonian crisis can be triggered by many different stress factors. A recent bout of illness, an increase in thyroid medication or IVF treatment could have caused this condition in the above-mentioned patient. Several theories have been proposed as to how neuropsychiatric symptoms come about in Addison’s disease patients. A relationship between hypoglycemia and psychiatric symptoms has also been suspected. Another speculated cause of the psychiatric symptoms in Addisonian patients is the shortage of cortisol, the main glucocorticoid in the human body. Cortisol diffuses through the target cell membrane and binds to the intracellular receptor. This hormone-receptor complex then enters the nucleus and causes transcriptional change. These glucocorticoid receptors are especially abundant in the hippocampus area of the brain. Cortisol deficiency results in massive cell death in the hippocampus, leading to memory impairment and cognitive changes in the patient.

Conclusion

An Addisonian patient may not necessarily exhibit symptoms typical of others, like nausea and fainting. As shown in this article, psychiatric symptoms may be first noticeable instead of physical ones. Mood swings and sudden behavioural changes should be picked up and treated as a possible case of Addison’s disease. This could prevent a potentially fatal Addisonian crisis or minimize an encephalopathy in patients. The real cause of mental disturbance in Addisonian patients is still being discovered. However, researchers have theorized that electrolyte and metabolic abnormalities such as low blood glucose levels and glucocorticoid shortage have relations to the mental state of Addison’s disease patients.


[532 words]
Reference:
The neuropsychiatric profile... [J Neuropsychiatry Clin Neurosci. 2006] - PubMed - NCBI. 2012. The neuropsychiatric profile... [J Neuropsychiatry Clin Neurosci. 2006] - PubMed - NCBI. [ONLINE] Available at:http://www.ncbi.nlm.nih.gov/pubmed/17135373. [Accessed 02 August 2012].