PSYCHIATRIC MANIFESTATIONS OF ENDOCRINE DISORDERS: DIAGNOSTIC CHALLENGES IN CLINICAL PSYCHIATRY

Endocrine disorders can present with depression, anxiety, cognitive impairment, behavioral change or psychosis, sometimes before their physical manifestations are recognized. For psychiatrists, the difficulty extends beyond identifying a possible medical mimic: endocrine disease, primary psychiatric illness, treatment effects and psychosocial distress may coexist. This narrative review examines these diagnostic challenges using a predefined collection of clinical studies, reviews, guidance and illustrative case reports. Particular attention is given to thyroid and adrenal disease, with complementary discussion of pituitary disorders, calcium disturbances, diabetes and reproductive or developmental factors. Psychiatric phenomenology rarely identifies a specific endocrine cause, while abnormal hormone concentrations may reflect established gland disease, medication exposure, acute illness or physiological adaptation. Observational associations therefore require careful separation from evidence of causation in an individual patient. Clinical assessment should integrate symptom chronology, collateral information, physical findings, medication history and appropriately interpreted laboratory results. Treatment resistance or an altered course should prompt diagnostic reconsideration when accompanied by relevant systemic features, but neither finding independently establishes an endocrine etiology. Improvement after endocrine treatment can strengthen causal attribution, although concurrent psychiatric interventions and incomplete recovery complicate interpretation. Persistent psychiatric symptoms after biochemical normalization require renewed assessment rather than automatic attribution to either unresolved endocrinopathy or an unrelated psychiatric disorder. The available literature supports coordinated psychiatric and endocrine care but provides limited evidence validating universal screening panels or diagnostic prediction rules. Prospective studies should evaluate diagnostic yield, time to recognition, patient functioning and psychiatric outcomes alongside biochemical measures.