Hiroi Naoki, Yoshihara Aya, Sue Mariko, Yoshino Gen, Higa Mariko
Department of Diabetes and Endocrinology, Saiseikai Yokohamashi-Tobu Hospital, Yokohama, Kanagawa, Japan.
Clin Med Insights Case Rep. 2010;3:55-8. doi: 10.4137/ccrep.s5812. Epub 2010 Sep 27.
A 68 year-old Japanese man, who had been suffering from immobilization and disuse syndrome, was admitted to our hospital for evaluation of polyuria with polyposia, hyponatremia and low blood pressure. His plasma osmolality was greater than that of his urine. His endocrinological examination revealed low levels of plasma adrenocorticotropic hormone (ACTH) and cortisol, and a normal response of ACTH to the corticotrophin-releasing hormone (CRH) challenge. Plasma ACTH did not increase with insulin loading. A low plasma vasopressin (AVP) level and no response of AVP to a 5% saline administration were observed. We diagnosed central adrenal insufficiency with central diabetes insipidus. Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk. In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression. However, a correct early diagnosis is necessary, because, if adrenal insufficiency is not definitively diagnosed, the patient's quality of life diminishes markedly.
一名68岁的日本男性，长期患有制动和废用综合征，因多尿伴烦渴、低钠血症和低血压入院接受评估。其血浆渗透压高于尿液渗透压。内分泌检查显示血浆促肾上腺皮质激素（ACTH）和皮质醇水平较低，ACTH对促肾上腺皮质激素释放激素（CRH）激发试验反应正常。胰岛素负荷后血浆ACTH未升高。观察到血浆血管加压素（AVP）水平较低，且给予5%盐水后AVP无反应。我们诊断为中枢性肾上腺功能不全合并中枢性尿崩症。开始使用氢化可的松和1-去氨基-8-D-精氨酸加压素治疗6个月后，他的心理症状有所改善，治疗开始1.5年后，他能够行走。总之，肾上腺功能不全被误诊为抑郁症并非特别罕见。然而，正确的早期诊断是必要的，因为如果肾上腺功能不全未得到明确诊断，患者的生活质量会显著下降。
