严重精神障碍作为肾上腺功能不全的主要表现。
Severe psychotic disorder as the main manifestation of adrenal insufficiency.
作者信息
Farah Julia de Lima, Lauand Carolina Villar, Chequi Lucas, Fortunato Enrico, Pasqualino Felipe, Bignotto Luis Henrique, Batista Rafael Loch, Aprahamian Ivan
机构信息
Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), Institute of Psychiatry, Dr. Ovidio Pires de Campos, 785-1 Andar, Ala Sul, Sala Chefias Médicas, 05403-010 São Paulo, SP, Brazil.
出版信息
Case Rep Psychiatry. 2015;2015:512430. doi: 10.1155/2015/512430. Epub 2015 Apr 12.
We describe a case of severe psychotic disorder as the only manifestation of primary adrenal insufficiency. A 63-year-old man presented with psychotic symptoms without any prior psychiatric history. During the clinical and laboratorial investigation, exams revealed a normovolemic hyponatremia. The patient showed no other clinical signs or symptoms compatible with adrenal insufficiency but displayed very high ACTH and low serum cortisol concentrations. Brain magnetic resonance imaging showed no significant changes, including the pituitary gland. The patient was initially treated with intravenous corticosteroids, resulting in rapid remission of the psychotic symptoms. The association between adrenal insufficiency and neuropsychiatric symptoms is rare but these symptoms can often be the first clinical presentation of the disease.
我们描述了一例以严重精神障碍为原发性肾上腺功能不全唯一表现的病例。一名63岁男性，既往无精神病史，现出现精神症状。在临床和实验室检查中，发现患者存在血容量正常的低钠血症。该患者没有其他与肾上腺功能不全相符的临床体征或症状，但促肾上腺皮质激素水平极高，血清皮质醇浓度极低。脑部磁共振成像显示无明显变化，包括垂体。患者最初接受静脉注射皮质类固醇治疗，精神症状迅速缓解。肾上腺功能不全与神经精神症状之间的关联较为罕见，但这些症状往往可能是该疾病的首发临床表现。
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