Psychoendocrine disorders
Changes in hormone levels inevitably affect higher nervous activity. Psychoendocrine syndrome manifests as personality defects, decreased intelligence and memory, and in severe cases, psychoses.
- Decreased mental activity: the patient becomes uninitiative, the range of interests narrows. An important difference from schizophrenia is that in endocrine pathology, a person maintains an adequate reaction to the surrounding environment.
- Changes in drives: instincts can either fade or pathologically intensify, although true perversions are rare.
- Emotional instability: lability, inexplicable anxiety, fear, and dissociated reactions (e.g., motor retardation against the background of euphoria) are characteristic.
Constitutional types and metabolism
In the late 1930s, M.V. Chernorutsky identified three constitutional types, each with its own endocrine and metabolic features:
- Asthenic type. Tall people with long, thin limbs and a narrow chest. Dissimilation predominates in them, basal metabolism and glucose utilization are accelerated. Prone to hyperthyroidism, arterial hypotension, peptic ulcer disease, and severe tuberculosis. Often found among patients with schizophrenia.
- Hypersthenic type. Stocky patients with a wide chest, long torso, and protruding abdomen. Assimilation processes predominate, metabolism is slowed down. A tendency to hypothyroidism and hypophysis hypofunction is characteristic, but adrenal activity is increased. Predisposed to metabolic syndrome, diabetes, atherosclerosis, and cholelithiasis.
- Normosthenic type. Proportional physique with balanced metabolism. Endocrine glands function harmoniously; vulnerable areas are the respiratory organs and the musculoskeletal system.
Hyperfunction of the adrenal cortex
Excessive secretion of adrenal cortex hormones leads to specific metabolic shifts. The most striking example is hypercorticism, which is based on chronic excess of glucocorticoids. Cushing's disease (pituitary adenoma produces excess ACTH) and Cushing's syndrome (autonomous tumor in the adrenal gland itself) are distinguished.
Clinical phenotype:
- Rapid weight gain with centripetal fat distribution (moon-shaped crimson face, "cervicodorsal fat pad", large abdomen with thin arms and legs).
- Protein catabolism: muscle atrophy, systemic osteoporosis, the appearance of wide crimson-cyanotic stretch marks (striae) on the skin.
- Arterial hypertension and impaired carbohydrate metabolism (insulin resistance).
- In children, a specific marker is the combination of hypertension with sharp growth retardation.
Adrenal hypofunction
Adrenal cortex insufficiency can be partial (e.g., isolated hypoaldosteronism) or total. Addison's disease is a chronic deficiency of all cortical hormones. Most often (in 50–65% of cases) it has an autoimmune nature, when antibodies destroy the cortex, leaving the medulla intact. With tuberculosis damage, both zones are destroyed. Another common cause is iatrogenic withdrawal syndrome after abrupt cessation of steroid intake.
Patients suffer from severe weakness, weight loss, hypotension, and hypoglycemia. Systemic melanosis—pronounced skin pigmentation—is characteristic.
Adrenal crisis An acute form of insufficiency. It manifests as a catastrophic drop in blood pressure, hypothermia, and shock. In children against the background of severe infections (meningococcus, sepsis), a fulminant form with a fever up to 41.5 °C can develop. Due to the complete absence of catecholamines, blood vessels dilate paretically, and antemortem lividity spots appear on the body. Without emergency care, the crisis quickly ends in coma and death.
Cushing's phenotype is easily remembered as "a moon on thin legs with stretch marks": moon face, dysplastic truncal obesity, limbs thinned due to muscle atrophy, and crimson striae on the abdomen.
Class and exam questions
How to distinguish Cushing's disease from syndrome?
The disease has a central origin (a pituitary tumor secretes an excess of ACTH, stimulating the adrenals), while the syndrome is peripheral (a tumor grows in the adrenal gland itself and works autonomously).
How to distinguish asthenic type from hypersthenic type by metabolism?
In asthenics, substance breakdown (dissimilation) predominates, metabolism is accelerated, and thyroid function is often increased. In hypersthenics, accumulation (assimilation) dominates, metabolism is slowed down, and there is a tendency to obesity and metabolic syndrome.
What is iatrogenic Addison's disease?
This is adrenal insufficiency caused by medical actions. With prolonged glucocorticoid treatment, the patient's own adrenals "get lazy" and atrophy. With abrupt drug withdrawal, a hormonal deficiency occurs.
How does adrenal damage in tuberculosis differ from autoimmune damage?
The autoimmune process destroys only the adrenal cortex. In generalized tuberculosis, specific inflammation destroys both the cortical and medullary substance of the gland.
What else to study on this topic
- Pathogenesis of the polyol pathway in hypercorticism and diabetic neuropathy
- Mechanisms of virilization in adrenogenital syndrome
- Differential diagnosis of hyperaldosteronism
- Ectopic ACTH syndrome: causes and manifestations
- The role of HLA-DR3 and DR4 antigens in autoimmune adrenal damage
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