Mental disorders associated with abnormal pituitary function
Introduction
Introduction to mental disorders associated with abnormal pituitary dysfunction Psychiatric disorders associated with hyperactivity of the anterior pituitary gland (giant disease or acromegaly) are mental disorders and neurological symptoms caused by excessive secretion of various growth hormones in the anterior pituitary gland. The anterior pituitary dysfunction accompanied by mental disorders refers to the anterior pituitary dysfunction caused by inflammation of the anterior pituitary gland, tumor, necrosis or surgery, and the secretion of hormones is reduced, which leads to secondary gonads, thyroid and adrenal cortex. Sexual dysfunction, a disorder in which the endocrine system and the nervous system regulate each other, leading to brain dysfunction and mental disorders. The psychiatric disorder associated with hypoplasia of the pituitary gland (diabetes insipidus) is a mental disorder and physical symptoms caused by a decrease or lack of secretion of antidiuretic hormone (ADH) caused by thalamic-neuronal pituitary lesions. Pituitary anterior dysfunction with mental disorders is most commonly due to postpartum pituitary ischemia, necrosis and atrophy caused by Shehanhansyndrome (Sheehansyndrome), accounting for about 70%, common in placenta retention, placenta previa caused by childbirth Time and postpartum hemorrhage lead to blood pressure drop, shock, if not timely blood transfusion, it can cause pituitary avascular necrosis, pituitary atrophy, pituitary body is physiological hypertrophy during pregnancy, blood vessels are rich, due to the sudden drop in placental hormone concentration after delivery, The pituitary gland rapidly recovers, the blood vessels contract, and the blood supply is reduced. At this time, the pituitary is particularly sensitive to ischemia, so it is prone to atrophy and necrosis of the pituitary. Postpartum hemorrhage can also cause pituitary vascular reflex spasm, damage the blood vessel wall and produce thrombosis. In addition, puerperal infection, amniotic fluid embolism, sepsis can also cause necrosis of the pituitary artery, or due to the formation of extensive thrombosis in the diffuse intravascular coagulation pituitary gland, all of which can cause the pituitary atrophy and produce hypopituitarism, postpartum sepsis, amniotic fluid Embolization or disseminated intravascular coagulation causes the patient to be called Simon-Siehan syndrome, and has been reported to give birth. The degree and timing of blood pressure drop are related to the extent of pituitary lesions. It is suggested that patients with this disease have symptoms of brain insufficiency before delivery. Because of massive bleeding and shock during childbirth, the occurrence and development of mental disorders are promoted. Pituitary function before delivery. It is more important than incomplete hemorrhage and shock after childbirth. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: loss of libido, coma, dehydration
Cause
Causes of mental disorders associated with abnormal pituitary dysfunction
Giant disease or acromegaly (25%):
The function of the anterior pituitary gland is hypertrophy, including acromegaly or acromegaly. The disease is called giant disease before adulthood, and the acromegaly is caused by excessive growth of the anterior pituitary gland. Growth hormone (GH) causes mental disorders and neurological symptoms caused by soft tissues, bones, visceral hypertrophy and endocrine and metabolic disorders.
Xi Han syndrome (25%):
The most common cause of anterior pituitary dysfunction with mental disorders is Sheehan syndrome, followed by postpartum pituitary ischemia, necrosis and atrophy, followed by intracranial infection, tumor compression and infiltration, surgery or radiation injury, Vascular lesions (such as arteriosclerosis), systemic diseases (such as chronic renal failure), severe malnutrition, and no cause can be found, and idiopathic hypopituitarism associated with impaired immune function can be associated with mental disorders.
Genetics (20%):
Posterior pituitary hypofunction (diabetes insipidus) is divided into central (hypothalamic-pituitary) and renal, which can occur at any age, more common in young people, more male than female, central diabetes collapse The majority of the disease accounted for the idiopathic and secondary categories: idiopathic diabetes insipidus accounts for about 30% to 50% of the disease, clinically no cause can be found, a small number of patients have a family History may be related to heredity. Some autopsy found that the hypothalamus has degenerative changes. Secondary diabetes insipidus is mostly caused by inflammation of the hypothalamus-pituitary, tumor, surgery, and trauma.
Renal diabetes insipidus: the patient's plasma antidiuretic hormone (ADH) is not lacking, but the renal tubular epithelial cells are not sensitive to ADH reaction. No matter the kind of diabetes insipidus, the body water abnormality caused by a large amount of urination, such as Excessive drinking water causes water poisoning, and dehydration is restricted by drinking water. Diabetes insipidus can cause mental disorders.
Pathogenesis
The mental disorder associated with hyperactivity of the anterior pituitary gland is a mental disorder and neurological symptoms caused by excessive secretion of various growth hormones in the anterior pituitary gland.
The most common anterior pituitary dysfunction with mental disorders is Sheehan syndrome caused by postpartum pituitary ischemia, necrosis and atrophy, accounting for about 70%, common in placenta retention, placenta previa, etc. During childbirth and postpartum hemorrhage causes blood pressure to drop, shock, if not timely blood transfusion, it can cause pituitary avascular necrosis, pituitary atrophy, pituitary body is physiological hypertrophy during pregnancy, blood vessels are rich, due to the sudden drop in blood placental hormone concentration after delivery The pituitary gland rapidly recovers, the blood vessels contract, and the blood supply is reduced. At this time, the pituitary gland is particularly sensitive to ischemia, so it is prone to atrophy and necrosis of the pituitary gland. Postpartum hemorrhage can also cause pituitary vascular reflex spasm and damage the blood vessel wall. Thrombosis, in addition to puerperal infection, amniotic fluid embolism, sepsis can also cause necrosis of the pituitary artery, or due to the formation of extensive thrombosis in the diffuse intravascular coagulation pituitary gland, all of which can cause the pituitary atrophy and produce hypopituitarism, from postpartum sepsis, Amniotic fluid embolism or disseminated intravascular coagulation causes the patient to be called Simon-Siehan syndrome, and has been reported to give birth. The extent and timing of post-blood pressure decline is related to the extent of pituitary lesions. It is suggested that patients with this disease have symptoms of brain insufficiency before delivery. Due to hemorrhage and shock during childbirth, the occurrence and development of mental disorders are promoted, and the pituitary gland before delivery. Insufficient function seems to be more important than bleeding and shock after childbirth.
Intracranial infection, tumor compression and infiltration, surgical or radiation injury, vascular disease (such as arteriosclerosis), systemic diseases (such as chronic renal failure), severe malnutrition, etc. may be associated with hypopituitarism, and some pituitary dysfunction There is no reason to find, may be related to immune function defects, called idiopathic hypopituitarism, and its associated mental disorders are explained: 1 pituitary dysfunction can directly cause mental disorders. 2 secondary endocrine dysfunction, said hypopituitarism can promote other types of endocrine gland hypofunction, such as gonads, thyroid, adrenal cortex and other secondary dysfunction leading to mental disorders, causing mental disorders and acute Gastroenteritis, respiratory tract infection, hypoglycemia, Addison's disease, overwork, surgery and psychological factors, as well as the application of a large number of hypnotics, sedatives, etc., when severe, can induce the crisis of anterior pituitary dysfunction, after the pituitary gland Leaf hypofunction (diabetes insipidus) is often caused by water metabolism disorders, causing mental disorders.
Prevention
Prevention of mental disorders associated with abnormal pituitary dysfunction
The treatment of mental disorders is carried out in both the cause and the symptom. Often the first symptomatic treatment after treatment.
Developing a scientific and reasonable lifestyle and eating habits can help treat the disease.
A better personality and psychology will help to alleviate the development of mental symptoms after illness.
Complication
Psychological disorders associated with abnormal pituitary dysfunction Complications, libido, coma, dehydration
In the early stage, there was excessive sweating, sexual desire, and later sexual loss. Can be expressed as depression, depression, anxiety, restlessness, depression, depression, self-blame, depression, anxiety, increased physical complaints, suspected illness, self-blame, self-crime and suicidal concept. Some patients may appear indifferent, dull, lazy, personality changes. Irritability, irritability, restlessness, etc. Often drowsiness, easy to fall asleep or paralyzed, disordered state, severe seizures and varying degrees of disturbance of consciousness, lethargy, paralysis, confusion and even coma. Dizziness, headache, fatigue, fatigue, thirst, muscle pain, dehydration, etc.
Symptom
Symptoms of mental disorders associated with pituitary dysfunction common symptoms dementia daytime sleepiness nighttime insomnia consciousness fuzzy consciousness disorder mental disorder irritability thinking incoherent fatigue victimization paranoia
1. Hyperactivity of the anterior pituitary gland (giant disease or acromegaly) with mental disorders.
(1) Mental symptoms:
1 personality change: early emotional instability, irritability, anxiety, restlessness, impatience, irritability, insomnia, forgetfulness, nervousness, etc., later mentally euphemistic, dull, slow, indifferent, less moving, ignorant, etc. Symptoms occur alternately between the two groups. Some people think that this personality change is the basic symptom of acromegaly mental disorder and is interpreted as a hook-and-shoulder episode that may be caused by the compression of the hook.
2 delusional state: even visible murder, relationship, delusion, illusion is rare.
3 manic or depressed state: manic performance is short, depression is heavier, and more often in the later stages of the disease.
4 Dementia status: poor thinking, comprehension difficulties, slow response, and memory loss and computational power are mild, in addition to disturbance of consciousness, often drowsiness, drowsiness, paralysis, acute psychosis and schizophrenic psychosis are rare.
(2) neurological symptoms: mainly local compression symptoms of pituitary adenoma such as headache, tinnitus, visual field reduction, blurred vision, optic disc edema and atrophy, some patients may develop neuritis, mostly in the median nerve, and some due to median nerve paralysis Carpal tunnel syndrome.
(3) Others: sweating in the early stage, hyperactivity, and loss of sexual desire in the later stage.
2. Pituitary anterior dysfunction with mental disorders The mental and neurological symptoms caused by this disease are not uncommon. According to domestic literature, about 90% of cases have various degrees of neuropsychiatric symptoms.
(1) Mental disorders:
1 cerebral weakness syndrome: more common symptoms of the disease, mostly in early or mild patients, clinical symptoms are often not obvious, but lasting longer, indifferent, slow, fatigue, fatigue, daytime sleepiness at night, insomnia, memory Decreased, silent, speechless, sluggish, anorexia, dizziness, etc., often misdiagnosed as neurasthenia.
2 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : :
3 schizophrenic state of psychosis: excitement and incitement, inconsistent thinking, can have vivid horror visual hallucinations and auditory hallucinations, delusions are more common in victimization, accompanied by auditory hallucinations, common in long-term cases, in addition to loneliness , smirk, impulsive, life lazy or performance intentions diminishing, silence, violation, stupid and so on.
4 Depression status: can be expressed as depression, depression, anxiety, restlessness, depression, depression, self-blame, depression, anxiety, increased physical complaints, suspected illness, self-blame, self-crime and suicidal concept.
5 disturbance of consciousness: sudden emergence of paralysis state, is a short-lived dream-like experience that occurs before the disordered state, ambiguous, disordered state, acute onset is often acute, and can gradually enter a coma state, if not actively rescued Death, some patients may have paroxysmal ambiguity, excitement, unclear, accompanied by vivid and vivid horror illusion, clear consciousness after seizure, good self-awareness, coma often occurs after a disorder or squatting, Often associated with hypoglycemia, hyponatremia, infection, hunger, fatigue are often predisposed factors, some of the disturbances of consciousness appear immediately after major bleeding, a few cases can occur several years after delivery.
6 chronic organic encephalopathy: some patients may appear indifferent, dull, lazy, personality changes.
The occurrence of various mental disorders mentioned above is mainly caused by the mutual regulation of central nervous system and endocrine system. Hypoglycemia is also one of the causes. The appearance of all mental disorders in the morning and evening and the severity of symptoms are not only related to the course of the disease, but also to the extent of pituitary damage. contact.
(2) Neurological and physical symptoms: neurological symptoms include headache, dizziness, syncope, seizures, myoclonus, hand and foot movements, pyramidal tract signs, etc. Physical symptoms are pale, nausea, vomiting, hair thinning, breast and Genital atrophy, hypoglycemia, hypothermia, hypotension, etc.
3. The hypophyseal function of the posterior pituitary gland (diabetes insipidus) is accompanied by mental disorders.
(1) Neuropsychiatric symptoms: often occur in the absence of water or dehydration, mostly caused by water metabolism disorders.
1 mental activity diminished: showing psychomotor inhibition, slow response, ignorance, slow movement, etc.
2 emotional instability: irritability, irritability, restlessness, etc.
3 disturbance of consciousness: consciousness disturbances often occur in water loss or water poisoning, often have drowsiness, easy to fall asleep or paralyzed, disordered state, severe seizures and varying degrees of disturbance of consciousness, lethargy, paralysis, confusion and even coma.
(2) Physical symptoms: dizziness, headache, fatigue, fatigue, thirst, muscle pain, dehydration, etc.
Examine
Examination of mental disorders associated with abnormal pituitary dysfunction
1. There is evidence of pituitary lesions.
2. Symptoms and signs of pituitary dysfunction.
3. Psychiatric symptoms change with the development of physical symptoms.
4. It should be differentiated from other endocrine dysfunction accompanied by mental disorders and other functional mental illnesses such as schizophrenia, snoring and depression.
Laboratory tests: Laboratory changes must be made to the primary pituitary disease.
Other auxiliary examinations: Pituitary disease associated with mental disorders without specific examination, only low amplitude amplitude slow waves, more alpha and waves are mixed in the EEG examination. It is non-specific.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with abnormal pituitary dysfunction
Diagnostic criteria
1. There is evidence of pituitary lesions.
2. Symptoms and signs of pituitary dysfunction.
3. Psychiatric symptoms change with the development of physical symptoms.
4. It should be differentiated from other endocrine dysfunction accompanied by mental disorders and other functional psychosis, such as schizophrenia, snoring and depression.
Differential diagnosis
Should be associated with other endocrine dysfunction associated with mental disorders and other functional psychosis, such as schizophrenia, snoring and depression.
