Objectives: To audit the endocrine referrals from a High Secure Hospital (HSH) to a department of endocrinology.
Methods: During the study, the HSH had approximately 400 beds, 75% male, 75% mental illness (mostly schizophrenia), 25% psychopathic personality disorders. The average length of stay in the HSH was 8 years, the majority of patients receive antipsychotic drugs (APD) and obesity and cigarette smoking is common.
Results: Over 10 years, 52 patients, median age 41 years, were seen. The endocrine conditions in order of frequency were:
Males (n=31): Thyrotoxic Graves disease (7), Hypothyroidism (6), Klinefelters syndrome (5), Hyponatremia and overdrinking (3), Miscellaneous (10).
Females (n=21): APD induced hyperprolactinemia, galactorrhoea, amenorrhoea (11), thyrotoxic Graves disease (6), Miscellaneous (4).
Conclusions: In this HSH, the commonest endocrine problem in males was thyrotoxic Graves disease, a condition relatively unusual in men. In several of these patients, marked deterioration in behaviour occurred when they were hyperthyroid.
In the female patients, galactorrhoea amenorrhoea secondary to APD induced hyperprolactinemia was commonest. Treatment with dopamine agonists was usually successful with no deterioration of mental state.