自身免疫性肾上腺炎致原发性肾上腺功能不全患者急性躁狂1例

IF 1.3 4区 医学 Q3 PSYCHIATRY
Nolan J Brown, Alex Wang, Gianna Fote, Chris Gabriel, Reza Farokhpay, John Luo
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引用次数: 0

摘要

我们描述了一个罕见的急性躁狂在设置自身免疫性肾上腺炎。男性,41岁,既往无精神病学诊断,因急性肾上腺危机住院治疗2天后接受低剂量皮质类固醇治疗,现表现为冲动、浮夸、心灵感应妄想和超宗教。脑病和狼疮性脑炎的检查结果为阴性,这引起了人们对这种表现可能代表类固醇性精神病的关注。然而,停用皮质类固醇5天并没有缓解患者的躁狂发作,提示其临床表现更可能是原发性情绪障碍的新发或肾上腺功能不全本身的精神表现。决定对患者原发性肾上腺功能不全(以前称为Addison病)重新开始皮质类固醇治疗,同时给予利培酮和丙戊酸治疗躁狂症和精神病。在接下来的2周内,患者的躁狂症状消失,出院回家。他最后的诊断是继发于自身免疫性肾上腺炎的急性躁狂。虽然肾上腺功能不全引起的急性躁狂相当罕见,但临床医生应该意识到与Addison病相关的精神病学表现的范围,以便他们能够为这些患者寻求最佳的医学和精神治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Mania in a Patient With Primary Adrenal Insufficiency Due to Autoimmune Adrenalitis: A Case Report.

We describe a rare case of acute mania in the setting of autoimmune adrenalitis. A 41-year-old male with no previous psychiatric diagnoses presented with impulsivity, grandiosity, delusions of telepathy, and hyperreligiosity following a previous hospitalization for an acute adrenal crisis and 2 subsequent days of low-dose corticosteroid treatment. Workups for encephalopathy and lupus cerebritis were negative, raising concern that this presentation might represent steroid-induced psychosis. However, discontinuation of corticosteroids for 5 days did not resolve the patient's manic episode, suggesting that his clinical presentation was more likely new onset of a primary mood disorder or a psychiatric manifestation of adrenal insufficiency itself. The decision was made to restart corticosteroid treatment for the patient's primary adrenal insufficiency (formerly known as Addison disease), coupled with administration of both risperidone and valproate for mania and psychosis. Over the following 2 weeks, the patient's manic symptoms resolved, and he was discharged home. His final diagnosis was acute mania secondary to autoimmune adrenalitis. Although acute mania in adrenal insufficiency is quite rare, clinicians should be aware of the range of psychiatric manifestations associated with Addison disease so that they can pursue the optimal course of both medical and psychiatric treatment for these patients.

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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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