CommentThis case fits the criteria for mania listed by the Diagnostic and Statistical Manual of Mental Disorders (3rd edition) and the ninth revision of the International Classification of Diseases.The association of mania and myxoedema must be very rare, and we can find no other reported case. 1-5The two usual psychiatric syndromes seen in myxoedema are, firstly, confusion and cognitive impairment resembling dementia, sometimes with clouding of consciousness; and, secondly, depressed mood with paranoid delusional ideas and often hallucinations.' 2 Irritability and violence are reported only in association with paranoid cases.2Our patient showed no psychiatric disorder until further metabolic disturbance was superimposed on his thyroid deficiency.After surgery he had a mental disturbance which may have been mild hypomania, which suggests that he may have been particularly susceptible to develop a mental disturbance from metabolic abnormality as an expression of his genetic predisposition indicated by the positive family history.We thank Professor J T Silverstone for his help and advice in preparing this report.
PMID 3120860 3120860 DOI 10.1136/bmj.295.6605.1027-a 10.1136/bmj.295.6605.1027-a
Cite this article
Dalton, K., Dalton, M. E., & Guthrie, K. (1987). Incidence of the premenstrual syndrome in twins. British medical journal (Clinical research ed.), 295(6605), 1027-1028. https://doi.org/10.1136/bmj.295.6605.1027-a
Dalton K, Dalton ME, Guthrie K. Incidence of the premenstrual syndrome in twins. Br Med J (Clin Res Ed). 1987;295(6605):1027-1028. doi:10.1136/bmj.295.6605.1027-a
Dalton, K., et al. "Incidence of the premenstrual syndrome in twins." British medical journal (Clinical research ed.), vol. 295, no. 6605, 1987, pp. 1027-1028.
A double blind, randomised, crossover trial of oral micronised progesterone (two months) and placebo (two months) was conducted to determine whether progesterone alleviated premenstrual complaints. Twenty three women were interviewed premenstrually before treatment and in each month of treatment. They completed Moos's menstrual distress questionnaire, Beck et al's depression inventory, Spielberger et al's state anxiety inventory, the mood adjective checklist, and a daily symptom record. Analyses of data found an overall beneficial effect of being treated for all variables except restlessness, positive moods, and interest in sex. Maximum improvement occurred in the first month of treatment with progesterone. Nevertheless, an appreciably beneficial effect of progesterone over placebo for mood and some physical symptoms was identifiable after both one and two months of treatment. Further studies are needed to determine the optimum duration of treatment.
Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted. The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health. Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause. Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.
Insulin resistance and hyperinsulinaemia significantly influence female hormone regulation and reproductive health. Despite increasing research, the complex pathways by which nutritional and metabolic signals regulate reproductive function remain poorly understood. Sex hormone-binding globulin (SHBG) is a key protein whose function is modulated by hyperinsulinaemia, liver function, and metabolic status, thereby influencing the active signalling of circulating sex steroids and intracellular signalling, which in turn, impacts endocrine and reproductive physiology. Consequently, SHBG serves as a valuable biomarker for understanding the metabolic-hormonal interactions within the endocrine axis. Ketogenic diets have demonstrated efficacy in reversing insulin resistance, resolving markers of liver disease, and improving metabolic health. In this study, we investigated the impact of suppressing ketosis (hypoketonaemia) on biomarkers of female reproductive and endocrine function in the Ketosis Suppression and Ageing cohort. Ten lean (BMI, 20.52 kg/m2 ± 1.39), healthy, premenopausal women (mean age, 32.30 ± 8.97 years), who maintained nutritional ketosis for an average of 3.9 years (± 2.3), participated in a 21-days of baseline data-collection in euketonaemia, 21-days of hypoketonaemia, and 21-days return to euketonaemia. Suppression of ketosis resulted in a significant 0.67-fold decrease in SHBG levels (p = 0.0015). SHBG was significantly and inversely associated with insulin (p = 0.0010), insulin resistance score (HOMA-IR; p = 0.0012), glucose ketone index (GKI; p = 0.0183), leptin (p = 0.0016), insulin-like growth factor-1 (IGF-1; p = 0.0172), free T3 (p = 0.0001), and gamma-glutamyl transferase (GGT; p = 0.0024). A significant positive association between SHBG and GLP-1 (p = 0.0295) was observed. Menstrual cycle phase was a statistically significant predictor of follicle-stimulating hormone (FSH) levels, with higher FSH levels during ovulation than during the follicular phase (p = 0.0097). SHBG is a sensitive biomarker of metabolic-endocrine status, with broader implications for cancer, and reproductive function. Chronic hypoketonaemia negatively affects SHBG production and hormonal balance. The implications of sex-hormone regulation for cancer prevention and therapy are discussed.
Reproductive EndocrinologyMenstrual Cycle
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