Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
Department of Psychiatry, The University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
Gen Hosp Psychiatry. 2014 Jul-Aug;36(4):449.e3-5. doi: 10.1016/j.genhosppsych.2014.02.012. Epub 2014 Mar 5.
We report a 59-year-old man with isolated adrenocorticotropin (ACTH) deficiency. The patient presented with sudden onset of delusions and hallucinations at the age of 54, which resolved gradually without treatment. Subsequently, the patient manifested stereotypy, wandering, hypobulia, and autistic symptoms, and was treated with antipsychotics for 1 year without any improvement. He suffered from neuroleptic malignant syndrome-like symptoms at the age of 59. A thorough endocrine assessment revealed isolated ACTH deficiency. After hydrocortisone supplementation, the physical and psychiatric symptoms improved dramatically. Clinicians should consider this rare disease when diagnosing patients with refractory psychiatric symptoms and unique physical symptoms of isolated ACTH deficiency.
我们报告一例 59 岁男性孤立性促肾上腺皮质激素（ACTH）缺乏症。患者 54 岁时突然出现妄想和幻觉，未经治疗逐渐缓解。随后，患者出现刻板行为、漫游、活动减少和自闭症症状，接受抗精神病药物治疗 1 年无改善。59 岁时出现类恶性神经阻滞剂综合征样症状。全面内分泌评估发现孤立性 ACTH 缺乏症。补充氢化可的松后，躯体和精神症状显著改善。当诊断难治性精神症状和具有独特的孤立性 ACTH 缺乏症的躯体症状的患者时，临床医生应考虑这种罕见疾病。
