Iwata Masaaki, Hazama Gen-i, Shirayama Yukihiko, Ueta Toshiyuki, Yoshioka Shin-ichi, Kawahara Ryuzo
Division of Neuropsychiatry, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University.
Seishin Shinkeigaku Zasshi. 2004;106(9):1110-6.
This report describes a 52-year-old male patient with idiopathic Addison's disease presenting depression as a first symptom. His psychomotor inhibition, depressive mood, sleep disturbances, general fatigue, muscular pain, and arthralgia were considered to be due to intense work in a stressful environment. Neither his physician nor his orthopedist found any physical disease. Therefore, he was diagnosed with endogenous depression by a psychiatric clinic, and antidepressants were prescribed. Antidepressants were not sufficient for improving his symptoms, and he was admitted to our hospital. Endocrine blood examination revealed primary adrenocortical insufficiency. Treatment with glucocorticoid induced rapid improvement in both the psychiatric and physical symptoms. It is well known that psychiatric symptoms occur in the progressive stage of Addison's disease. At present, however, the occurrence of psychiatric symptoms is very rare, mainly because of a decrease in the incidence of this disease or an increase in mild cases. In addition, Addison's disease presenting with psychiatric features in the early stage has the tendency to be overlooked and misdiagnosed. Thus, we suggest the necessity of blood work for ACTH and cortisol in the field of psychiatry.
本报告描述了一名52岁男性特发性艾迪生病患者，首发症状为抑郁。其精神运动抑制、抑郁情绪、睡眠障碍、全身乏力、肌肉疼痛和关节痛被认为是由于在压力环境下高强度工作所致。其内科医生和骨科医生均未发现任何躯体疾病。因此，一家精神科诊所诊断他患有内源性抑郁症，并开了抗抑郁药。抗抑郁药不足以改善他的症状，于是他住进了我院。内分泌血液检查显示原发性肾上腺皮质功能不全。糖皮质激素治疗使精神症状和躯体症状迅速改善。众所周知，精神症状出现在艾迪生病的进展期。然而目前，精神症状的发生非常罕见，主要是因为该疾病的发病率下降或轻症病例增多。此外，早期以精神症状为表现的艾迪生病容易被忽视和误诊。因此，我们建议在精神病学领域有必要进行促肾上腺皮质激素（ACTH）和皮质醇的血液检查。
