Taipei City Psychiatric Centre, Taipei City Hospital, Taiwan.
Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):574.e9-10. doi: 10.1016/j.genhosppsych.2012.07.008. Epub 2012 Aug 15.
Hyperosmia may be an early manifestation of hypocortisolism and may be mistakenly diagnosed as osmophobia. However, sertraline therapy incidentally alleviated the phobic symptoms and hindered accurate diagnosis.
A 41-year-old man was diagnosed as having osmophobia. Initial sertraline treatment relieved the symptoms, but its cessation resulted in recurrence of osmophobia. Endocrinological examinations revealed severe hypocortisolism and partial hypopituitarism with isolated adrenocorticotropic hormone deficiency. After prednisolone supplementation, his condition dramatically improved.
We recommend that, before intervention with selective serotonin reuptake inhibitors is performed, the hypothalamic-pituitary-adrenal axis be evaluated in psychiatric patients presenting with co-occurring olfactory change.
嗅觉过度可能是皮质醇功能减退的早期表现，可能会被误诊为嗅觉恐惧症。然而，舍曲林治疗偶然缓解了恐惧症症状，阻碍了准确的诊断。
一名 41 岁男性被诊断为嗅觉恐惧症。初始舍曲林治疗缓解了症状，但停药后嗅觉恐惧症复发。内分泌检查显示严重的皮质醇功能减退和部分垂体功能减退，伴有孤立性促肾上腺皮质激素缺乏。泼尼松龙补充后，病情显著改善。
我们建议，在对同时出现嗅觉改变的精神科患者进行选择性 5-羟色胺再摄取抑制剂干预之前，应评估下丘脑-垂体-肾上腺轴。
