Hormones in the Mind: Four Faces of Endocrine-triggered Psychiatric Syndromes

Background: Endocrine disorders can produce prominent psychiatric symptoms that may mimic primary psychiatric illnesses. When psychiatric manifestations dominate the clinical picture, the underlying endocrine pathology may remain unrecognised, leading to delayed diagnosis and inappropriate treatment. Early identification of hormonal abnormalities is therefore critical in atypical psychiatric presentations. Methods: We present a case series of four patients who presented primarily with acute psychiatric syndromes but were subsequently diagnosed with distinct endocrine disorders. Psychiatric diagnoses were established according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Symptom severity was assessed using standardised rating scales, and patients underwent targeted endocrine investigations based on clinical suspicion. Results: The cases included hyperthyroidism presenting with psychotic mania, primary hyperparathyroidism with hypercalcaemia causing acute psychosis, pheochromocytoma mimicking panic disorder and Addison’s disease presenting as severe depressive illness with psychotic features. In all cases, endocrine evaluation revealed the underlying disorder, and targeted endocrine treatment led to marked improvement or complete resolution of psychiatric symptoms. Short-term psychotropic medications were required only in the acute phase. Conclusions: Endocrine disorders may masquerade as primary psychiatric conditions across multiple endocrine axes. Incorporating basic endocrine screening in atypical, first-episode or rapidly evolving psychiatric presentations can improve diagnostic accuracy, facilitate timely treatment and prevent unnecessary long-term psychotropic use.