What are common medical conditions that can present with anxiety in adults and adolescents?

Common Medical Conditions That Present with Anxiety

When evaluating anxiety symptoms in adults and adolescents, you must systematically rule out endocrine, cardiac, respiratory, metabolic, and substance-related causes before diagnosing a primary anxiety disorder. 1

Endocrine and Metabolic Conditions

The most critical medical mimics involve hormonal and metabolic dysregulation:

• Hyperthyroidism is a primary masquerader, causing anxiety through excessive thyroid hormone production that directly triggers sympathetic nervous system activation 1, 2
• Hypoglycemic episodes and diabetes provoke panic-like symptoms through blood sugar fluctuations, particularly in patients with poor glycemic control 1, 2
• Pheochromocytoma causes episodic catecholamine surges that perfectly mimic panic attacks with palpitations, sweating, and tremor 1

Order thyroid function tests and glucose levels when signs of these conditions are present, rather than routinely screening all anxiety presentations 1

Cardiovascular Conditions

Cardiac pathology frequently presents with anxiety symptoms that overlap substantially:

• Cardiac arrhythmias initiate panic-like episodes with palpitations, chest discomfort, and fear of dying 1, 2
• Cardiac valvular disease (particularly mitral valve prolapse) has been historically associated with panic disorder, though the relationship is complex 1

The challenge here is bidirectional: anxiety causes cardiac symptoms, and cardiac disease causes anxiety symptoms 3

Respiratory Conditions

Respiratory disorders create a particularly confusing clinical picture:

• Asthma overlaps dramatically with panic symptoms, both presenting with dyspnea, chest tightness, and fear of suffocation 1, 2, 3
• Hypoxia from any cause triggers anxiety as a physiologic response to oxygen deprivation 1

The key pitfall is dismissing respiratory complaints as "just anxiety" when actual bronchospasm or hypoxemia is present 2, 4

Neurological Conditions

Central nervous system disorders commonly manifest with anxiety:

• Migraines present with anxiety and autonomic symptoms as part of the prodrome or aura phase 1, 2
• Central nervous system disorders broadly (including seizure disorders, cerebral palsy) have high comorbidity with anxiety symptoms 1, 3

Chronic Pain and Inflammatory Conditions

Persistent medical conditions create both physiologic and psychological anxiety:

• Chronic pain/illness of any type triggers anxiety through persistent physiologic stress and functional impairment 1, 2
• Systemic lupus erythematosus causes anxiety through both CNS involvement and the psychological burden of chronic autoimmune disease 1

Gastrointestinal Conditions

GI disorders are bidirectionally linked with anxiety:

• Gastrointestinal disorders (irritable bowel syndrome, gastroesophageal reflux disease) both cause and result from anxiety through the gut-brain axis 1, 3
• Dysmenorrhea in adolescent girls and women can trigger anxiety symptoms during menstrual cycles 1

Substance-Induced Anxiety

Substance use is among the most common and overlooked causes:

• Caffeinism (excessive caffeine intake) directly provokes anxiety and panic attacks through adenosine receptor antagonism 1, 2
• Medication side effects from various prescription drugs (corticosteroids, bronchodilators, thyroid replacement, stimulants) induce anxiety 1, 2
• Illicit drug use (particularly stimulants like cocaine, amphetamines) and withdrawal states create severe anxiety 1, 2
• Alcohol withdrawal produces rebound anxiety and panic as a cardinal feature 2

Always obtain a detailed substance use history including caffeine, over-the-counter medications, and supplements 1

Toxic and Environmental Exposures

Less common but important to consider:

• Lead intoxication can present with anxiety, particularly in children and adolescents with environmental exposure 1
• Allergic reactions may include anxiety as part of the systemic response 1

Clinical Approach to Differentiation

The diagnostic strategy requires targeted testing only when clinical features suggest specific conditions 1:

• Obtain thyroid function tests if there is heat intolerance, weight loss, tremor, or tachycardia
• Check glucose if there are episodic symptoms related to fasting or eating patterns
• Consider cardiac evaluation if there are chest pain, palpitations with exertion, or syncope
• Assess medication lists systematically for anxiogenic agents

Laboratory testing is not routine for anxiety evaluation but should be guided by specific clinical suspicion 1

Critical Pitfall to Avoid

The most dangerous error is attributing cardiac or respiratory deterioration to "just anxiety" and missing life-threatening medical conditions 2, 4, 5. When in doubt, rule out medical causes first, particularly in new-onset anxiety in patients over 35 years or with known medical comorbidities 5, 6.