Mood Changes Research Articles

8507 Misdiagnosis of Graves’ and RAI Treatment in Patient with THRB Gene Mutation

Abstract Disclosure: E. McBride: None. R. Kennedy: None. A.N. Davis: None. S.J. Healy: None. Introduction: Resistance to thyroid hormone (RTH) is an inherited condition in which there is decreased tissue responsiveness to thyroid hormone. Occasionally patients with this condition can be misdiagnosed with hyperthyroidism.Clinical case: A 35 yo female was referred to our clinic for evaluation of postablative hypothyroidism. 6 years prior, the patient was evaluated by endocrinology at our city’s army hospital. The patient had abnormal TFTs during HTN workup but was otherwise asymptomatic. Family history included goiter in paternal aunt and grandmother (s/p thyroidectomy). Labs showed TSH 0.370 mIU/L (0.3-3); FT4 2.01, repeat 1.96 ng/dl (0.6-1.6); FT3 6.10 pg/ml (2.3-4.4); T4 16.2 mcg/dl (4.5-12); alpha subunit 0.32ng/ml; TBG 31 mcg/ml (13-39). On exam patient had thyromegaly. Thyroid US showed normal gland with length 5.6 cm. Subsequent labs showed negative thyroglobulin ab, antithyroid microsomal ab, TBII, and TSI. Resistance to thyroid hormone (RTH) was suspected. Pt underwent RTH mutation analysis. Result was heterozygous for c.715T>A (pTrp239Arg) in exon 7 of the THRB gene, described as variant of unknown significance. Treatment was not recommended. Patient desired pregnancy and was evaluated by our hospital’s MFM clinic for preconception counseling. Per notes, patient had another child who tested negative for the gene.Patient then moved out of state, and 1 year later she underwent ablation for presumed diagnosis of Graves’ disease. The records from that hospital are not available. Patient later moved back to our city and was evaluated in clinic. At that visit, weight was 44 kg and patient was on 200 mcg LT4 daily. Pt endorsed cold intolerance, mood swings, brain fog, some hair loss. Recent thyroid US showed diminutive thyroid, and outside labs showed TSH 7.288, TPO ab <4. Our labs showed TSH 8.6 and FT4 2.05. Pt was still interested in becoming pregnant. She did not recall the prior genetic testing or diagnosis of RTH, and believed that she had Graves’. Patient did not return for follow up visit and later moved out of state.Conclusions: Patient’s labs showed elevated T4 and T3 with normal TSH. Genetic testing revealed a mutation in THRB gene. The normal codon is TGG coding for tryptophan and mutation in this patient is AGG coding for arginine. Other mutations in this same codon result in reduced T3 binding affinity.This patient was later was misdiagnosed as having Graves’ at an outside hospital, presumably due to labs and increased thyroid uptake. Patient underwent unnecessary RAI treatment. It is common for these patients to require higher than expected doses of thyroid hormone.This case illustrates the importance of obtaining outside records and correlating thyroid function tests with imaging studies. It is a reminder that not all cases of increased thyroid uptake are due to Graves’. Management of thyroid hormone can be challenging in patients with RTH who have undergone ablation. Presentation: 6/3/2024

12580 Factitious Cushing’s Syndrome Secondary To Indiscriminate Use Of Brazilian Herbal Medicine: Case Report

Abstract Disclosure: L. Warszawski: None. K.F. Seidel: None. C. Padilla: None. V.N. de Souza: None. J.R. Calmon: None. Background: Herbal medicines are obtained exclusively from active plant raw materials, which leads people to believe that these medications are safer and free from side effects. Moreira milk is a Brazilian herbal medicine used mainly for its supposed anti-inflammatory properties. This medication is not regulated by The Brazilian Health Regulatory Agency (Anvisa). Herein we report a case of exogenous Cushing's Syndrome (CS) caused by continuous use of Moreira milk. Case report: A 53-year-old female patient was seen in October 2018 at the endocrinology clinic due to progressive weight gain, mood swings, edema and weakness of the lower limbs, violet streaks on the flanks, easy bruising and dorsocervical fat pad. She brought tests to our specialized consultation that showed low basal cortisol (0.4 mcg/dL - RR 5 to 25 mg/dL) and ACTH ( %lt; 5 pg/ml - RR 10 to 60mg/dL), two HbA1c values above 6.5% and a sella turcica MRI revealing normal-sized pituitary gland with a hypo-enhancing contrast area, possibly corresponding to a microadenoma. New tests were carried out which showed the maintenance of low basal cortisol and ACTH. The patient reported background use of losartan and Moreira milk for 2 years - as a phytotherapy to control joint pain after Chikungunya. She denied use of topical, inhalatory or oral corticoids. Exogenous CS was suspected and the use of Moreira milk was interrupted. We proceeded to use prednisone for weaning, which had to be gradual, but the patient progressed with clinical improvement. Conclusion: There are some cases of hypercortisolism associated with herbal medicines, the majority of which are due to contamination with synthetic glucocorticoids, as is believed to occur with Moreira milk. Despite being widely sold in Brazil, because it is not approved by ANVISA, the production cannot be inspected, therefore, can be contaminated. Those cases of exogenous CS are challenging, and misidentifying Cushing's syndrome can result in a series of improper treatments with severe repercussions. Presentation: 6/1/2024

7829 Hydrocortisone Vs Prednisone During Recovery Following Surgical Cure For Endogenous Hypercortisolism: A Longitudinal Observational Study

Abstract Disclosure: R. Sandooja: None. J. Saini: None. R. Gregg garcia: None. C. Zhang: None. S. Achenbach: None. E. Atkinson: None. J. Van Gompel: None. W.F. Young: None. I. Bancos: None. Hydrocortisone vs Prednisone During Recovery Following Surgical Cure for Endogenous Hypercortisolism: A Longitudinal Observational Study Introduction: Glucocorticoid withdrawal syndrome (GWS) is a constellation of symptoms that occurs after successful surgery for endogenous hypercortisolism. The objective of this study is to compare hydrocortisone versus prednisone on GWS symptoms. Methods: Study design: Single-center prospective longitudinal cohort study, 2019-2023. Participants: Adults with Cushing syndrome (CS) and mild autonomous cortisol secretion (MACS) with post-operative adrenal insufficiency treated with either hydrocortisone or prednisone for glucocorticoid replacement. Measurements: Clinical and biochemical severity scores for hypercortisolism were calculated. Quality of life (QOL) was assessed using Short Form-36 (SF-36) and Cushing QOL surveys. GWS was assessed using weekly AddiQoL surveys for the first 12 weeks after surgery. Results: Of 131 patients, 91 (69%) patients were treated with hydrocortisone and 40 (31%) with prednisone. No differences in age (median age 51 vs 53 years, P=0.62), sex (84 vs 85% women, P=0.83), etiology of hypercortisolism (ACTH-dependent: 44% vs 48%, P=0.26), clinical severity of hypercortisolism (median score 13 vs 12, P=0.97), or biochemical severity of hypercortisolism (median score of 6 in both, P=0.31) were noted between groups. When assessed at 4-, 8-, and 12-weeks post-surgery, the prevalence and trajectory of symptoms (fatigue, myalgias/arthralgias, sleep, headaches, nausea, weakness) were similar in patients treated with hydrocortisone and prednisone (P>0.05 for all). However, patients treated with prednisone were less likely to report mood changes (8.5% vs 20.9%, P= 0.004) compared to those treated with hydrocortisone. When compared to the presurgical baseline, the overall Cushing QOL score 12 weeks post-surgery improved in both groups (mean delta 8.9 vs 13.0, P=0.21). No differences in the hydrocortisone vs prednisone treatment were found in the SF-36 physical component score (mean delta of -1.7 vs 0.3, P=0.23) and SF-36 mental component score (mean delta 2.3 vs 5.0, P=0.22). Using multivariable analysis, age (estimate 0.22, P= 0.005), clinical severity score (estimate -0.73, P<0.001), female sex (estimate -5.45, P= 0.046) but not glucocorticoid type (estimate -0.06, P=0.98) were associated with the overall GWS symptom burden at 12 weeks. Conclusion: Use of prednisone after curative surgery for hypercortisolism was associated with lower mood symptoms, but did not impact the overall severity or trajectory of other symptoms associated with GWS. Baseline clinical severity of hypercortisolism, age, and female sex were associated with GWS burden. Presentation: 6/1/2024

6572 Acute Adrenal Crisis Secondary To Undiagnosed Addison's Disease

Abstract Disclosure: J.M. Deirmenjian: None. H. Nickowitz: None. T. Kavafyan: None. Addison’s disease, also known as primary adrenal insufficiency, is when the adrenal gland has a defect in making cortisol. Signs and symptoms of Addison’s disease include nausea, vomiting, diarrhea, fatigue, dizziness, hyperpigmentation, and mood changes. Acute Adrenal Crisis can occur as a result of Addison’s disease when patients experience acute physiologic stress such as acute illness. Patient is a 35- year-old woman with a PMHx of iron deficiency anemia presenting with intractable nausea and vomiting for 10 days and a single witnessed syncopal episode two days prior to presentation. She was also had intermittent dizziness. Patient initially presented to urgent care where she was found to be hyponatremic and then was sent to the ED. She had no seizure like activity or rashes prior to admission. On initial physical exam, her skin was warm and dry with skin discoloration and hyperpigmentation. She was awake, alert, and oriented to person, place, time, and situation. Patient had no neurological deficits and no lateral or vertical nystagmus on initial assessment. On admission, patient was hyponatremic to 114 mEq/L, potassium was 5.0 mEq/L, and glucose level was 79 mg/dL. Despite receiving a 500 cc NS bolus, 1L NS bolus, 25 grams of albumin, and D5-0.45 NS at 50 cc/hr, the hyponatremia was difficult to correct. Her sodium initially corrected to 120 mEq/L but the sodium later decreased to 117 mEq/L. The morning after admission, patient became hypotensive and hypoglycemic. Random cortisol was measured and found to be 2.2 mcg/dL, raising concern for acute adrenal crisis as a result of undiagnosed Addison’s Disease. ACTH level was 17 pg/mL. Endocrinology was consulted and she was treated with IV 100 mg Hydrocortisone in addition to IV hydrocortisone 50 mg IV q6h. Patient was able to be transitioned to PO hydrocortisone 15 mg qAM and 5 mg qPM and was started on PO fludrocortisone 0.1 mg daily. On day of discharge, sodium improved to 127 mEq/L. CT Abdomen with contrast was completed to evaluate the adrenal glands and it showed a normal appearance of the adrenal glands. The etiology of the patient’s acute adrenal crisis was secondary to undiagnosed Addison’s Disease. It is interesting to note that patient was not hypoglycemic on admission but later became hypoglycemic during her hospital course. Adrenal crisis is a possible fatal complication of undiagnosed Addison’s disease. Therefore, a possible Addison’s Disease diagnosis is important to consider when patients are presenting with symptoms such as nausea, vomiting, dizziness, and electrolyte derangements including hyponatremia. If patient’s present with hyponatremia, ruling out possible adrenal insufficiency by checking a cortisol level may change the course of patient’s care. After discharge, she was able to establish care with Endocrinology and remain stable on treatment with PO hydrocortisone and PO fludrocortisone. Presentation: 6/3/2024

8604 Ectopic Cushing’s Syndrome Associated with a Metastatic Pancreatic Mixed Neuroendocrine Non-neuroendocrine Neoplasm (MiNEN) with Amphicrine Features

Abstract Disclosure: A. DeMarsilis: None. C. Jiang: None. O. Lavrynenko: None. D. Motavalli: None. C. Musurakis: None. Z.H. Taxin: None. E.D. Rosen: Advisory Board Member; Self; Source Bio, Inc.. Consulting Fee; Self; Novartis Pharmaceuticals, Gensaic. M.S. Irwig: None. Background: Ectopic Cushing’s Syndrome (CS) makes up 9-18% of ACTH-dependent CS cases, of which fewer than 15% are attributed to pancreatic neuroendocrine tumors (1). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) are rare, aggressive carcinomas, often driven by high-grade neuroendocrine components, with a poor prognosis (2). Amphicrine neoplasms contain neuroendocrine and exocrine components in the same cell. Clinical Case: A 34 year-old woman with asthma, hypertension, and depression presented with new onset lower extremity edema, facial hirsutism, mood changes, polyuria and polydipsia. She had an elevated morning serum cortisol of 52 ug/dL (normal < 20) with plasma ACTH 42 pg/mL (normal < 50), 24-hour urine free cortisol of 1003 mcg (normal < 50), K+ of 2.6 mEq/L, and fasting glucose 164 mg/dL. CT showed multiple hepatic lesions, pulmonary nodules, a pancreatic tail lesion, and lymphadenopathy concerning for metastatic disease. Her adrenal glands were thickened bilaterally without nodules. A pituitary MRI was normal. These findings were concerning for ectopic CS. She was admitted due to rapidly developing symptoms. Potassium, insulin, sitagliptin, and prophylactic anticoagulation were started. Spironolactone and ketoconazole were initiated while awaiting biopsy results of liver and pancreas lesions. Osilodrostat was not available and a trial of metyrapone was poorly tolerated. The liver and pancreatic tail lesion biopsy revealed metastatic MiNEN with amphicrine features, of pancreatic origin, with Ki67 proliferation index of 70%. Section staining of pancreas and liver biopsies were negative for ACTH. A Ga-68 Dotatate scan showed minimal uptake, so octreotide was not prescribed. Palliative chemotherapy was planned. Although ketoconazole was titrated to 1600 mg/day, urine free cortisol levels and serum free cortisol levels did not reach target. Cushing disease was considered but not suspected, as ACTH levels remained modest despite a relative decrease in cortisol level. Given significant morbidity from uncontrolled hypercortisolism, and plans for urgent initiation of systemic chemotherapy, after multidisciplinary discussion the patient was treated with a surgical bilateral adrenalectomy. Post-operative morning serum cortisol measured 8.3 ug/dL. After one week, palliative chemotherapy with FOLFIRINOX (oxaliplatin, leucovorin, fluorouracil, and irinotecan) was initiated. She was discharged home on stress dose steroids with plan for taper. Conclusion: Ectopic ACTH secretion is a rare phenomenon, particularly when presenting with a rare case of metastatic pancreatic MiNEN with amphicrine features, associated with significant morbidity. To improve tolerance and survival of further treatment, early surgical bilateral adrenalectomy should be considered.

6400 An Unusual Presentation of Silent Corticotroph Pituitary Macroadenoma

Abstract Disclosure: N. Mon: None. V. Lohano: None. B. Williams: None. N. Lehman: None. R. Kulkarni: None. S.L. Mokshagundam: None. Silent Corticotroph Pituitary Adenomas (SCA) are a rare group of nonfunctioning pituitary adenomas (NFA) comprising 3-6% of all pituitary adenomas and up to 20% of corticotroph adenomas. SCA are biologically and clinically distinct from Cushing disease and NFA. SCA present with headache, visual field impairment, hypopituitarism, and pituitary apoplexy. We present a case of SCA with the initial presentation of syncope with undetectable ACTH and very low AM cortisol level.A 67 year-old-female was incidentally found to have a pituitary macroadenoma in MRI brain for syncope work up in 2017. MRI reported 1.4 x 1.2 x 1.3 cm sellar mass with suprasellar extension, minimal mass effect on the optic chiasm and no cavernous sinus invasion. Initial labs showed ACTH <5 (7.2-63.3 pg/mL), AM cortisol 0.8 (6-28ug/dl), Prolactin 101.1 (3.3-27 ng/mL), TSH 0.08 (0.34-5.60 uIU/mL), Free T4 0.6 (0.58-1.64 ng/dL), FSH 1.7 (2-5 mIU/mL), LH <0.2 (1-13 mIU/mL), IGF-1 33 ( 41-279 ng/mL). ACTH stimulation test: cortisol 0.5 ug/dl at baseline, 5.8 ug/dl at 60min. She was diagnosed with panhypopituitarism and hyperprolactinemia due to stalk effect. Hydrocortisone and Levothyroxine (LT4) were started. She underwent pituitary macroadenoma resection for optic chiasm decompression in 2017. Pathology reported pituitary neuroendocrine tumor (pitNET), but no immunostaining was done at that time. Follow up MRI in 2019 showed residual pituitary tumor. In 2023, she endorsed headaches, mood changes, fatigue and weight gain. Physical exam was unremarkable except BMI 34.75. Prolactin, Free T4, IGF-1 were normal. MRI in 2023 revealed recurrent and enlarging pituitary adenoma (1.9 x 1.4 x 1.6 cm) with suprasellar extension, abutting the optic chiasm, and left cavernous sinus invasion with internal carotid artery encasement. She underwent revision transsphenoidal resection of pituitary tumor to decompress the optic chiasm with plan for subsequent focused radiation to the cavernous sinus portion. Postoperative period was uneventful and hydrocortisone and LT4 were continued on discharge. Final pathology reported silent corticotroph lineage pitNET with low Ki67, immunostaining positive for TPIT, CAM5.2, and negative for ACTH. ACTH-negative SCA are a rare subtype and more likely to have lower ACTH levels, and multiple microcysts on MRI than ACTH-positive SCA. New WHO classification of pitNET highlights the histological typing and subtyping based on immunostaining of pituitary lineage transcription factors as the cornerstone for accurate classification. SCA are more biologically aggressive tumors with a high propensity of recurrence and resistance to conventional treatment. TPIT and ACTH immunostaining significantly improved the diagnosis of SCA and thereby close clinical follow up for early recognition and management of SCA recurrence. Absence of serum markers of recurrence makes this challenging. Presentation: 6/1/2024

12437 Impact Of Wearable Brain Sensing Meditation Device On Quality Of Life In Patients Recovering From Hypercortisolism Following Surgical Intervention: A Prospective Longitudinal Cohort Study

Abstract Disclosure: J. Saini: None. B. Bahrani Fard: None. M. Suresh: None. R. Sandooja: None. Y. Hleibiehova: None. E. Atkinson: None. S. Achenbach: None. I. Bancos: None. Background: Patients with endogenous hypercortisolism experience glucocorticoid withdrawal syndrome (GWS) following curative surgery. The symptoms of GWS include fatigue, weakness, muscle aches, joint pain, mood changes, and sleep disturbance. Limited interventions have been explored to alleviate the symptoms of GWS and improve patients’ quality of life. The use of meditation as an intervention has been reported to enhance postsurgical recovery in patients with other conditions and offers a promising intervention for GWS. Objective: To determine the impact of a portable, wearable, electroencephalographic device (MUSE headband device) used for guided meditation practices on the quality of life of patients in the first 12 weeks post-surgery for endogenous hypercortisolism. Methods: We conducted a single-center prospective longitudinal study of adults with endogenous hypercortisolism undergoing curative surgery between 2018 and 2024. The patients were enrolled before the surgical intervention and were followed for 2 years. Only patients who completed at least 4 weeks of follow-up were included. The study comprised of 2 groups; (1) The interventional group included consecutive patients who were offered a MUSE headband with instructions to meditate for at least 10 minutes per day for 3 months (MUSE cohort) and (2) the comparison group included age-, sex-, clinical score, hypercortisolism type, and BMI-matched 3:1 patients (Referent cohort). Quality of life and symptoms of GWS were assessed with AddiQoL and Short Form-36 (SF-36) surveys. Results: At least 4 weeks post-surgical follow-up was completed by 27 patients in the MUSE cohort and 81 referent subjects. Age (median 51 vs 47 years), women (82% vs 84%), BMI (median 31 vs 32 kg/m2), the subtype of hypercortisolism (pituitary 48% vs 52%), clinical (median 16 vs 15) and biochemical (median 6 vs 7) severity scores were similar between the two groups (P>0.05 for all). At baseline, AddiQoL score was similar in groups (median of 66 vs 70, P=0.083), though symptoms of fatigue (92.6% vs 69.1%, P=0.015) and lightheadedness (37% vs 17.3%, P=0.033) were more frequent in MUSE cohort. After 12 weeks, 20 patients using MUSE demonstrated improvement compared to 67 no muse patients in the SF-36 physical component (mean delta 3.9 (SD 11.77) vs -2.19 (SD 9.67), P=0.010). The physical functioning SF-36 subcomponent (4.94 (8.77) vs 0.92 (9.24), P=0.048) and body pain SF-36 subcomponent (2.69 (11.89) vs -3.69 (8.32), P=0.008) domains improved in the MUSE intervention group, when compared to referent cohort. No significant improvement in SF-36 mental component scores was seen in both groups. Conclusions: The use of wearable electroencephalographic device for meditation was associated with improvement in the quality of life of patients recovering from hypercortisolism, particularly in the domains of body pain and physical functioning. Presentation: 6/3/2024

12372 A Rare Case Of Silicon Granulomatosis Induced Hypercalcemia In A Transgender Female

Abstract Disclosure: O.A. Aluko: None. I. Singh: None. Introduction: Hypercalcemia has been described in patients with most granulomatous disorders, of which sarcoidosis and tuberculosis are the most common. Granuloma formation is a rare, however well known complication of silicon implants and injections. We present a case of silicon granulomatosis induced hypercalcemia in a transgender female. Case Report 60-year-old transgender female, with past medical history of HIV on HAART was referred to Endocrinology for evaluation of hypercalcemia. She Bloodwork done a few weeks prior revealed elevated calcium 12.3 and low PTH of 9. Reported symptoms include worsening abdominal pain similar to prior gastritis flare, insomnia and significant weight loss. Denied any constipation, joint pain, mood changes, no history of bone fractures or kidney stones. Admitted to significant dairy intake - half a gallon of milk within 3 days and daily yogurt consumption. Endorsed inadequate daily fluid intake and she was not taking oral calcium or Vitamin D supplementation. Quit tobacco 9 years ago. Vitals were significant for tachycardia with HR 120/min, BP stable. Patient was referred to the ER for IV hydration and further evaluation with initial suspicion of malignancy. Repeat corrected calcium was 14.7, ionized calcium 6.8, PTHrP undetectable <2, borderline high 1,25 dihydroxyvitamin D 74.5, low vitamin D 17.9 and normal free T4 1.5. ACE, SPEP, UPEP levels within normal limits. Vitamin A low. CT chest/abdomen/pelvis revealed innumerable soft tissue foci in the subcutaneous adipose tissue of the flanks and lateral gluteal areas; nodular liver, suspected cirrhosis and portal hypertension. Imaging findings prompted further discussion regarding prior procedures. She endorsed history of silicone fillers in hips and breast implants 30 years ago. Images reviewed with radiology confirmed calcification around bilateral breast implants, with intracapsular rupture. Calcium improved with IV Fluids, bisphosphonates and steroids. The most probable cause of hypercalcemia was believed to be secondary to silicone granulomatosis. Innumerable granulomas were deemed irresectable, removal of the breast implants considered however not performed. She was later diagnosed with hepatitis B, cirrhosis and succumbed to sepsis and multiorgan failure. Conclusion Eliciting a detailed history, physical exam and correlating with imaging findings is imperative to establishing an uncommon diagnosis. PTHrP was low and there were no bony metastases making the possibility of malignancy related hypercalcemia less likely. FDG-PET if performed would reveal hypermetabolic nodules, often an initial indication to the underlying etiology. Presentation: 6/2/2024

Amygdala activity after subchronic escitalopram administration in healthy volunteers: A pharmaco-functional magnetic resonance imaging study.

Selective serotonin reuptake inhibitors (SSRIs) are used for the treatment of several conditions including anxiety disorders, but the basic neurobiology of serotonin function remains unclear. The amygdala and prefrontal cortex are strongly innervated by serotonergic projections and have been suggested to play an important role in anxiety expression. However, serotonergic function in behaviour and SSRI-mediated neurobiological changes remain incompletely understood. To investigate the neural correlates of subchronic antidepressant administration. We investigated whether the 2- to 3-week administration of a highly selective SSRI (escitalopram) would alter brain activation on a task robustly shown to recruit the bilateral amygdala and frontal cortices in a large healthy volunteer sample. Participants performed the task during a functional magnetic resonance imaging acquisition before (n = 96) and after subchronic escitalopram (n = 46, days of administration mean (SD) = 15.7 (2.70)) or placebo (n = 40 days of administration mean (SD) = 16.2 (2.90)) self-administration. Compared to placebo, we found an elevation in right amygdala activation to the task after escitalopram administration without significant changes in mood. This effect was not seen in the left amygdala, the dorsomedial region of interest, the subgenual anterior cingulate cortex or the right fusiform area. There were no significant changes in connectivity between the dorsomedial cortex and amygdala or the subgenual anterior cingulate cortex after escitalopram administration. To date, this most highly powered study of subchronic SSRI administration indicates that, contrary to effects often seen in patients with anxiety disorders, subchronic SSRI treatment may increase amygdala activation in healthy controls. This finding highlights important gaps in our understanding of the functional role of serotonin.

Beyond Birth Control: The Neuroscience of Hormonal Contraceptives.

Hormonal contraceptives (HCs) are one of the most highly prescribed classes of drugs in the world used for both contraceptive and noncontraceptive purposes. Despite their prevalent use, the impact of HCs on the brain remains inadequately explored. This review synthesizes recent findings on the neuroscience of HCs, with a focus on human structural neuroimaging as well as translational, nonhuman animal studies investigating the cellular, molecular, and behavioral effects of HCs. Additionally, we consider data linking HCs to mood disorders and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and stress response as a potential mediator. The review also addresses the unique sensitivity of the adolescent brain to HCs, noting significant changes in brain structure and function when HCs are used during this developmental period. Finally, we discuss potential effects of HCs in combination with smoking-derived nicotine on outcomes of ischemic brain damage. Methodological challenges, such as the variability in HC formulations and user-specific factors, are acknowledged, emphasizing the need for precise and individualized research approaches. Overall, this review underscores the necessity for continued interdisciplinary research to elucidate the neurobiological mechanisms of HCs, aiming to optimize their use and improve women's health.

Seasonal variation in mood among individuals with and without bipolar disorder

IntroductionBipolar disorder is a disorder characterized by cyclic changes in mood, yet limited research has explored longitudinal patterns of seasonality on mood symptoms in this population. This study aimed to examine longitudinal mood symptoms in individuals with bipolar type I and II, and healthy controls to determine if seasonal patterns were present and to validate the Global Seasonality Score as a measure of seasonality. MethodsParticipants from the Prechter Longitudinal Study of Bipolar Disorder were included. Seasonal variations in mood were determined from the Patient Health Questionnaire, Altman Self-Rating Mania scale, and the Seasonal Pattern Assessment Questionnaire. Mixed effects models were utilized to examine the effects of season and diagnostic group on patterns of mood over time. ResultsAll groups exhibited significant seasonal effects on mood symptoms, with evidence of decreased depressive symptoms and increased mania symptoms in longer daylight months. The Global Seasonality Score showed significant differences between diagnostic groups, with bipolar I and II groups demonstrating higher seasonality than healthy controls. High seasonality was associated with greater variance in mood symptoms. ConclusionThe present study found evidence of seasonal patterns in mood symptoms in individuals with bipolar type I and II. These results highlight the need for consideration of seasonality in assessment and treatment in bipolar disorder and suggest that interventions such as light therapy during seasons of heightened risk could be beneficial. The validation of the Global Seasonality Score as a reliable measure further underscores the benefit of utilizing self-report measures to identify periods of vulnerability.

A case of severe Covid-19 infection as the first manifestation of Cushing's disease.

Cushing's disease (CD) is characterized by distinct syndromic features, often accompanied by obesity and depression. However, considering its gradual onset of symptoms, it is usually associated with diagnostic delays. In rare instances, CD may lead to severe infections due to the observed immunosuppression in affected individuals. We present a rare case of an undiagnosed CD in a 20-year-old male with a medical history of depression and obesity, complicated by severe COVID-19 infection. He presented to the Emergency Room with respiratory distress, hypertensive crisis, and fever, ultimately receiving the diagnosis of SARS-CoV-2 pneumonia. The patient required mechanical ventilation and intensive care unit (ICU) admission due to severe acute respiratory distress syndrome (ARDS). During ICU care, he received remdesivir and dexamethasone, subsequently developing severe hyperglycemia and worsened hypertension, requiring insulin and multiple antihypertensive agents to manage metabolic disruption. Upon physical examination, classic signs of hypercortisolism were noted. Subsequent laboratory tests and pituitary magnetic resonance imaging confirmed the diagnosis of CD. The patient underwent surgical resection with significant improvements in body composition and metabolic parameters postoperatively. After surgery, remission of hypercortisolism was evident, accompanied by notable improvements in mood and overall health. This case underscores the importance of recognizing hypercortisolism in the context of metabolic, physical, and mood changes. Timely diagnosis of CD is crucial to mitigate complications such as severe opportunistic infections and their outcomes. Despite some hallmark features such as proximal myopathy, easy bruising, purple striae, and facial plethora, Cushing's disease (CD) is a challenging diagnosis due to its nonspecific signs and symptoms and gradual onset. The case emphasizes the importance of recognizing subtle signs of CD, such as social isolation, depressive symptoms, and changes in body composition, which may be confounded by external factors like the COVID-19 pandemic. Patients with CD are prone to severe infections due to chronic hypercortisolism-induced immunosuppression. CD diagnostic delays are common, leading to worsening of metabolic and immune dysfunction over time. Heightened clinical suspicion and early intervention are essential to prevent diagnostic delays and optimize patient outcomes.

The Impact of Social Media Usage on Mental Health Among College Students: Patterns, Psychological Effects, and Implications for Well-being

This study explores the impact of social media usage on the mental health of college students, focusing on usage patterns and psychological effects. A descriptive research design was employed, with a sample size of 121 respondents selected through stratified random sampling. Data was gathered using a closed-ended questionnaire featuring a 5-point Likert scale. The findings reveal that social media consumption varies significantly among students, with a majority experiencing mood changes and potential addiction. Furthermore, the analysis highlights the influence of social media on daily activities, sleep patterns, and overall mental well-being. The study provides valuable insights into the relationship between social media usage and mental health, offering a foundation for future research on mitigating negative psychological impacts among students.

Affecting Factors and Seasonal Effects on the Continuous Positive Airway Pressure Adherence of Patients with Obstructive Sleep Apnea

Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence remains challenging. This study identifies factors influencing CPAP adherence, including the impact of Korea's four distinct seasons. A retrospective study of 650 patients with OSA and prescribed with CPAP was conducted at a single institution from January 2018 to December 2020, and the patients’ answers on various sleep questionnaires, demographic and polysomnographic data, and when and whether they returned the CPAP devices were collected and analyzed. The sample population was divided into when and whether the CPAP device was returned to the institution and the average daily use of the CPAP device. Results show that treatment failure is high in the first 12 weeks. Moreover, patients with more severe sleep apnea tended to have severe OSA-related clinical symptoms and are more likely to adhere to the treatment. In this study show that the seasons did not affect CPAP adherence because of indoor environmental factors. However, results show that other patient factors, such as BMI, AHI, RDI, daytime drowsiness, mood changes, and other OSA-related symptoms, have greater effects on CPAP adherence than seasonal change. initial positive experience is important to adapt to the CPAP, and for this reason, more active intervention by sleep physicians during the initial CPAP adaptation is necessary.

Seasonal mood variation in youth and young adults with bipolar spectrum disorder: A longitudinal prospective analysis.

To determine whether there are latitude and seasonal differences in the prevalence of mood episodes (depression and mania) in youth and young adults with Bipolar Spectrum Disorder (BD). Mood polarity was prospectively evaluated in 413 participants with BD. Participants were enrolled in the Course and Outcome of Bipolar Youth (COBY) study at three sites (University of California Los Angeles-UCLA, Brown University, and the University of Pittsburgh Medical Center-UPMC) and interviewed on average every 7 months for an average of 91.9 months (range: 6-228 months), with a total of 274,123 weekly mood ratings. Associations between light exposure and mood polarity were estimated using generalized linear mixed models with time-varying covariates, considering the latitude and seasonality of the study sites and other potential confounders. Average age at intake and at last assessment was 12.6 ± 3.3 and 27.2 ± 4.8 years-old, respectively. There were significantly more depressive episodes during winter than during summer, spring, and autumn. Considering latitude, UCLA showed significantly lower prevalence of depressive episodes, and an absence of seasonal pattern of depression, compared to the Brown/UPMC sites. For the entire sample, there were more manic/hypomanic episodes during summer than during winter. However, there were no significant between site seasonal differences in the prevalence of manic/hypomanic episodes. Depressive episodes are more prevalent during the winter and although less significant, manic/hypomanic episodes during the summer. Awareness and interventions to prevent or ameliorate the effects of seasonal variations in mood changes in BD are warranted.

Evaluation of Extended Decision Outcomes

ABSTRACTSome decision outcomes consist of sequences of single experiences. The aim is to propose a conceptualization of how such sequences are evaluated if affective evaluations of single experiences evoke transient emotional responses with lasting changes in current mood. The conceptualization implies three modes in which the sequences of single experiences are evaluated: (i) Aggregation of affective evaluations of the single experiences retrieved from memory; (ii) Aggregation of current moods associated with emotional responses to the single experiences retrieved or reconstructed from memory; and (iii) Updating of current mood. Simulations of parametrized models are used to compare the different evaluation modes to each other and to show to which extent the simulation results are consistent with some common findings in previous research. The previous research has primarily investigated different rules for aggregation of affective evaluations of single experiences. The simulation results motivate research comparing this mode to the other proposed modes.

Go with your gut! The beneficial mood effects of intuitive decisions.

People make countless decisions every day. We explored the self-regulatory function of decisions and assumed that the very act of making a decision in everyday life enhances people's mood. We expected that this decision-related mood change would be more pronounced for intuitive decisions than for analytical ones. The ease of making a decision and the feeling of rightness were expected to mediate the effect of intuitive (vs. analytical) decisions on participants' mood. In a preregistered experimental experience sampling study, participants from the general population were asked to report when they were about to make an everyday decision over the course of 14 days (N = 256 participants, 6,779 decisions). For each decision, participants were randomly instructed to decide either based on their intuition or based on careful analysis. We assessed several variables before and immediately after the decision. Participants also reported retrospectively on their choices in voluntary follow-up assessments. Making a decision per se immediately enhanced participants' mood. This mood enhancement was stronger for intuitive compared to analytic decisions and persisted until follow-up. Ease of decision, but not feeling of rightness, mediated this effect. Intuitive decisions compared to analytic decisions were more likely to be implemented and led to greater satisfaction and pleasantness of the chosen option. Having more options for a particular decision led to generally higher mood improvement and satisfaction. This is the first empirical demonstration showing that using one's gut has beneficial effects in everyday life. Study limitations and implications for theory and practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Drug Addiction Clinical Study Among Patients Admitted to the Alqana Center for Social Rehabilitation

Background: Drug addiction is a worldwide issue; 5.6% of the world's population aged 15 to 64 took drugs at least once in 2016. For the majority of medicines, younger individuals use them more than older people do. Drug abuse seems to be on the increase in several ASEAN (Association of Southeast Asian Nations) countries, particularly among young men aged 15 to 30. Illicit drug abuse account for around 14% of the overall health burden among young males. Younger individuals are also more prone to die from drug abuse issues. Aims of study is to assess the severity of problems related to drug addiction. in Baghdad city and to study epidemiological features of drug addiction among Patients Admitted to the Alqana Center for Social Rehabilitation. Patients and methods: An analytical cross-sectional study of 300 individuals diagnosed as a drug addiction patient according to the criteria established by the "Diagnostic and Statistical Manual of Mental Disorders", Fifth Edition, text revision, often called the DSM-V-TR or DSM-5-TR. From the medical department at Alqana Center for Social Rehabilitation in Baghdad. The research was carried out from 25/December/2023 to 30/June/2024. Results: the demographic characteristics of the study sample. In with a mean and a standard deviation (SD) of age of 29.33±18.68. Individuals aged 20-29 year had the highest proportion to addiction, with a rate of 42.7%. Conversely, 89.3% of the participants were male. The majority,86.7%, live in urban regions. The majority of patients had 51.7% unmarried, with only 36.0% being married and 12.3% was divorced. The main rate among drug addiction patients was 38.7% primary education ,33.0% secondary education, and 16.0% was illiterate patient, while lowest patient 12.3% at collage. According to the statistics in the table,76.3% of the participants were free business. 95.0% cigarette smoker. presented the result of psychological symptoms as show 93.0% of study addictive patient have mood swings, and in the same table the behavioral and social symptoms showed as 97.0% of study patient had poor performance and/or attendance at work or school. Also, physical symptoms of addiction showed as 74.7% of patient suffering from disrupted sleep patterns, including insomnia Regarding to the withdrawal symptoms of drug addiction presented in Table (3), results showed as 95.7% fatigue, 85.3% muscle pain or aches, 81.0% irritability and agitation, 76.0% trembling and tremors, 69.3% hunger, 50.7% anxiety, 36.7% sweating, 30.7% insomnia, 25.3% loss of appetite, 22.7% depression, 20.7% confusion, 22.3% nausea, 9.3% seizures, 8.0% dilated pupils, 3.3% vomiting, and 2.3% paranoia. Conclusion: the majority of addicted patient was male. the main symptoms were Poor performance and/or attendance at work or school and mood swing. The highly complication was fatigue. Regarding the way of addiction, the tablets is vast majority and enjoyment is the most common cause of addiction. Recommendations: It's possible that other important differences between the factors seen in this study would become clearer if multicenter study, the sample size was larger and the duration of the addiction study had been longer.

Sjögren’s disease, occupational performance and quality of life

Introduction: Sjögren’s disease is an autoimmune disease with dry eyes and mouth and chronic pain, more frequent in middle-aged women. The aim of this study is to understand the impact of Sjögren’s disease on quality of life and occupational health. Method: Quantitative and qualitative comparative study, with 20 Sjögren’s disease and 25 healthy controls. Questionnaires and interviews were applied to assess occupational performance, quality of life, mood disorders, and sleep. Results: The combined major diagnostic parameters for Sjögren’s disease (focus score and anti-SSA/Ro positivity) were present in 85% of the Sjögren’s disease group. There was a correlation between the sicca symptom measured by the European League Against Rheumatism Sjögren’s Syndrome Patient Reported Index (ESSPRI), anxiety, and depression measured by the Hospital Anxiety and Depression Scale (HADS; r = 0.56; p = 0.009), as well as fatigue measured by the Profile of fatigue and discomfort questionnaire (PROFAD) ( r = 0.78; p < 0.0001). Sjögren’s disease patients reported a loss of physical abilities, sleep disturbance, change in mood, social and occupational participation, and lower quality of life. Conclusions: Sjögren’s disease patients have poorer quality of life, loss of competencies, and sleep disturbances compared to controls. Novel strategies are necessary to improve occupational health in SjD.

Neurovascular Shifts, Sensory Sensitivity, and PMDD in Autistic Women: Exploring Blood Flow Redirection, Mood Dysregulation, and Pain Tolerance during Menstruation

This article examines the relationship between Premenstrual Dysphoric Disorder (PMDD), neurovascular dynamics, and sensory sensitivities in autistic women during menstruation. The redirection of blood flow to the uterus during the menstrual cycle has been found to exacerbate cerebral perfusion deficits in neurodivergent individuals, particularly in the Prefrontal Cortex (PFC), which contributes to the mood dysregulation and emotional instability characteristic of PMDD. Autistic women, who often exhibit heightened sensory sensitivities, experience intensified discomfort during menstruation, as sensory overload and altered pain perception compound the emotional challenges of PMDD. These findings emphasize the need for neurodivergent-friendly menstrual products that mitigate both physical and emotional discomfort. Additionally, innovations using biodegradable materials, smart fabrics, and custom-fit menstrual solutions are discussed as potential breakthroughs to improve the quality of life for autistic women managing PMDD. This research highlights the importance of addressing both neurobiological and sensory aspects when designing interventions for PMDD in neurodivergent populations.