Affective Disorder and Hyperandrogenism

摘要

A 40-year-old female patient with bipolar disorder and premenstrual dysphoric disorder did not present any physical evidence of virilization, treated with quetiapine and lithium carbonate. Laboratory testing showed evidence of hyperandrogenism (Testosterone levels 88.5ng/dL). After control, testosterone levels were normal (free testosterone 0.20 pg/ml, total testosterone 27.90ng/dl), as free thyroxine levels decreased (T4 0.83ng/dl) and increased progesterone levels (progesterone 3.80ng/ml). We consider an association between increased androgenic hormone levels in women, quetiapine and lithium carbonate treatment as well as the presence of an affective disorder and premenstrual dysphoric disorder. Some relevant patents are also outlined in this review. INTRODUCTION As one of the most common endocrinopathies, androgen excess affects approximately 7 of reproductive-aged women. Among this large cohort of women, the majority is diagnosed with polycystic ovary syndrome (PCOS). Successively, Isojarvi et al. reported a high frequency of polycystic ovaries and/or hyperandrogenism in a large series of women with epilepsy. The pathogenic mechanisms underlying the association between epilepsy and reproductive endocrine disorders are not yet clear. Antiepileptic drugs (AEDs), particularly acid valproate (VPA), may mediate this association however, the association between quetiapine, lithium carbonate with polycystic ovaries and/or hyperandrogenism remains unknown. There is little available research that empirically establishes clinical features that might increase the chances of premenstrual dysphoric disorder (PMDD), since this disease is more likely to occur in patients with a family history for both, PMDD or major depression, Perhaps the most crucial factor in establishing diagnosis of PMDD rules out another underlying medical or psychiatric diagnosis and shows a premenstrual exacerbation of symptoms. For example, more than 50 of patients suffering from major depression report a clear-cut premenstrual exacerbation in their depressive symptoms. Our case report presents a patient with bipolar disorder, premenstrual dysphoric disorder, treated with quetiapine, lithium carbonate was found to have elevated serum testosterone levels. The relationship among a possible hormonal alteration in bipolar disorder, PMDD, quetiapine and lithium carbonate treatment remains unknown.