부신기능저하증 증상 [Article] Secondary adrenal insufficiency misdiagnosed as depression: A case report

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精神身體醫學 = Korean journal of psychosomatic medicine,
v.19 no.2,

2011, pp.109-114  

Moon, Deok-Soo

(Department of Psychiatry, College of Medicine, Kyung Hee University)

Kang, Won-Seop

(Department of Psychiatry, College of Medicine, Kyung Hee University)

Baek, Jong-Woo

(Department of Psychiatry, College of Medicine, Kyung Hee University)

,

Song Ji-young

(Department of Psychiatry, College of Medicine, Kyung Hee University)

,

Kim Jong-woo

(Department of Psychiatry, College of Medicine, Kyung Hee University)
… After discharge, he was readmitted to the infectious disease department due to high fever and confusion, and was diagnosed with panhypopituitary hypofunction accompanied by adrenal dysfunction. His overall symptoms improved with cortisol administration. Hypothyroidism, adrenal dysfunction, and growth hormone deficiency due to pituitary dysfunction cause various nonspecific symptoms such as lethargy, fatigue, insomnia, weight loss, and decreased appetite. In clinical practice, patients with these nonspecific depressive symptoms require differential diagnosis for endocrine diseases.

The abnormalities in the hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71-year-old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardatio…
The abnormalities in the hypothalamic-pituitary-adrenal(HPA) axis are associated with many psychiatric symptoms including depression. We present a report of a 71 year old man who was admitted to the psychiatric department presenting symptoms of headache, avolition, loss of energy, psychomotor retardation, poor appetite, insomnia, anxiety resulting from adrenal insufficiency and hypopituitarism. Hypothyroidism and electrolyte disturbance were managed and headache, insomnia, anxiety, GI symptoms were improved. But he remained in anergic state. After discharge, he was readmitted to infection department with high fever and drowsy mentality. Adrenal insufficiency was recognized and he was treated with corticosteroid replacement therapy. Finally his diagnosis was made as panhypopituitarism and overall symptoms were resolved. In this case, we showed how the atypical symptoms resulting from hypopituitarism develop and progress. Hypothyroidism, adrenal insufficiency, and growth hormone deficiency resulting secondarily from panhypopituitarism were associated with various nonspecific symptoms such as loss of energy, fatigue, insomnia, weight loss, decreased appetite etc. In clinical situations, differential diagnosis with depression is needed when clinicians were meeting a patient with these nonspecific symptoms. It is important that laboratory tests and differential diagnosis with endocrine diseases should be conducted, especially in geriatric patients with nonspecific symptoms like anergia, fatigue, poor appetite and so on.
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