Wong Sophia, Hughes Barbara, Pudek Morris, Li Dailin
Department of Pathology and Laboratory Medicine, University of British Columbia, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9.
Case Rep Endocrinol. 2013;2013:815821. doi: 10.1155/2013/815821. Epub 2013 Oct 22.
Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752 nmol/day (normal, 89-470 nmol/day), epinephrine at 1045 nmol/day (normal, <160 nmol/day), and dopamine at 7.9 μ mol/day (normal, 0.4-3.3 μ mol/day). The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features.
恶性紧张症是一种罕见且致死率很高的神经精神疾病，其临床和生化表现可能与嗜铬细胞瘤相似。由于两种疾病的治疗方法差异很大，因此进行鉴别诊断至关重要。我们报告一例20岁男性恶性紧张症患者，该患者同时出现精神病性症状和自主神经功能不稳定，24小时尿去甲肾上腺素水平显著升高，达1752 nmol/天（正常范围89 - 470 nmol/天），肾上腺素水平为1045 nmol/天（正常范围<160 nmol/天），多巴胺水平为7.9 μmol/天（正常范围0.4 - 3.3 μmol/天）。该患者接受了多次电休克治疗，临床症状完全缓解。在此次发病数周内再次收集尿液显示，其儿茶酚胺和甲氧基肾上腺素水平恢复正常或接近正常。在鉴别诊断高儿茶酚胺状态时，应考虑恶性紧张症，尤其是在同时伴有紧张症特征的患者中。
