Clinial Relevance

Many patients, whether medical patients or psychiatric patients, feel they are receiving suboptimal care and feel their hormones are somehow playing a role in their illness, and yet this is commonly ignored in their treatment.

Patients often sense that they have a chemical imbalance. Appropriate endocrine testing can rule out subtle endocrine influences that may play a role in their illness. For example, subclinical hypothyroidism may be diagnosed, indicating a thyroid disorder that has more than subtle influences on the patient's sense of wellbeing. The mind/body dichotomy is never more apparent than in dealing with illness effecting the brain. Obviously, so called physical illness coexists with psychological illness so frequently that it is the rule rather than the exception. When one has a heart attack it may be initiated by neuroendocrine changes triggered by psychological events originating in our brains and propagated to end organs, including the heart. It is virtually never mind OR body; it almost always is a mind/body event. So ignoring the psychological elements of illness sometimes leads to inadequate medical care. My goal is to integrate the mind/body in a comprehensive approach to the patient's care. Therefore, during an interview we may switch from psychological to physical in a split second with no thought to that shift. After all, our mind/body knows of no such split.

Psychoneuroendocrinology is particularly relevant to understanding the perimenopause and menopause. Part of this understanding includes considering hormone replacement therapy with bio-identical hormones as a therapeutic option after considering the patient's genetic, family and medical history. When hormone replacement therapy is contraindicated, other treatments are often an effective alternative. For information about other treatments, vitamins, and nutraceuticals visit farmacopia.net.

Psychoneuroendocrinology is playing an increasing role in the diagnosis and treatment of mood and anxiety disorders. The study of the hypothalamic-pituitary-adrenal axis has become a fertile area of investigation in studying psychiatric disorders. Cortisol, an adrenal hormone, is frequently elevated in depression. This has led to the Dexamethasone Suppression Test that is positive in 50% of clinical depressions. The regulatory factors involved in cortisol secretion, including the hypothalamic hormone, CRF, are being studied as starting points for the identification of CRF receptor antagonists, which may become useful antidepressants. (See Neurocrine Biosciences). Prolactin is a pituitary hormone that is a useful marker of neuroendocrine dysfunction. Its elevation can lead to suppression of menstrual periods and associated psychiatric illness. Premenstrual depression is another neuroendocrine mediated disorder that is being carefully studied (see Psychoneuroendocrinology. p. 245). The role of stress in many disorders is an active area of investigation in psychoneuroendocrinology. One of the stress disorders, Posttraumatic Stress Disorder paradoxically is associated with a low serum cortisol. The thyroid disorders including hypothyroidism and hyperthyroidism commonly occur, or are causative factors, in mood disorders and should be ruled out in any complete evaluation of depression or mania. Vitamin deficiencies can provoke depression in susceptible individuals, and therefore screening for B12 and folic acid deficiency should be a part of the evaluation of mood disorders. Finally, in men a low testosterone level can be associated with a clinical depression with decreased libido, and therefore should be ruled out in men presenting with a mood disorder.