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Central adrenal insufficiency and diabetes insipidus misdiagnosed as severe depression.

Hiroi N, Yoshihara A, Sue M, Yoshino G, Higa M - Clin Med Insights Case Rep (2010)

Bottom Line: Plasma ACTH did not increase with insulin loading.Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk.In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes and Endocrinology, Saiseikai Yokohamashi-Tobu Hospital, Yokohama, Kanagawa, Japan.

ABSTRACT
A 68 year-old Japanese man, who had been suffering from immobilization and disuse syndrome, was admitted to our hospital for evaluation of polyuria with polyposia, hyponatremia and low blood pressure. His plasma osmolality was greater than that of his urine. His endocrinological examination revealed low levels of plasma adrenocorticotropic hormone (ACTH) and cortisol, and a normal response of ACTH to the corticotrophin-releasing hormone (CRH) challenge. Plasma ACTH did not increase with insulin loading. A low plasma vasopressin (AVP) level and no response of AVP to a 5% saline administration were observed. We diagnosed central adrenal insufficiency with central diabetes insipidus. Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk. In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression. However, a correct early diagnosis is necessary, because, if adrenal insufficiency is not definitively diagnosed, the patient's quality of life diminishes markedly.

No MeSH data available.


Related in: MedlinePlus

Coronal T1-weighted magnetic resonance imaging of the pituitary gland. The arrow indicates an empty sella.
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f2-ccrep-2010-055: Coronal T1-weighted magnetic resonance imaging of the pituitary gland. The arrow indicates an empty sella.


Central adrenal insufficiency and diabetes insipidus misdiagnosed as severe depression.

Hiroi N, Yoshihara A, Sue M, Yoshino G, Higa M - Clin Med Insights Case Rep (2010)

Coronal T1-weighted magnetic resonance imaging of the pituitary gland. The arrow indicates an empty sella.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3046013&req=5

f2-ccrep-2010-055: Coronal T1-weighted magnetic resonance imaging of the pituitary gland. The arrow indicates an empty sella.
Bottom Line: Plasma ACTH did not increase with insulin loading.Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk.In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes and Endocrinology, Saiseikai Yokohamashi-Tobu Hospital, Yokohama, Kanagawa, Japan.

ABSTRACT
A 68 year-old Japanese man, who had been suffering from immobilization and disuse syndrome, was admitted to our hospital for evaluation of polyuria with polyposia, hyponatremia and low blood pressure. His plasma osmolality was greater than that of his urine. His endocrinological examination revealed low levels of plasma adrenocorticotropic hormone (ACTH) and cortisol, and a normal response of ACTH to the corticotrophin-releasing hormone (CRH) challenge. Plasma ACTH did not increase with insulin loading. A low plasma vasopressin (AVP) level and no response of AVP to a 5% saline administration were observed. We diagnosed central adrenal insufficiency with central diabetes insipidus. Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk. In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression. However, a correct early diagnosis is necessary, because, if adrenal insufficiency is not definitively diagnosed, the patient's quality of life diminishes markedly.

No MeSH data available.


Related in: MedlinePlus