Korean J Psychosom Med.  2011 Dec;19(2):109-114.

Secondary Adrenal Insufficiency Initially Misdiagnosed as Depression: A Case Report

Affiliations
  • 1Department of Neuropsychiatry, School of Medicine, Kyung Hee University, Seoul, Korea. psyjong@gmail.com

Abstract

The abnormalities in 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 situation, differential diagnosis with depression is needed when clinicians were met 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.

Keyword

Adrenal insufficiency; Hypopituitarism; Depression

MeSH Terms

Adrenal Insufficiency
Anxiety
Appetite
Axis
Depression
Diagnosis, Differential
Endocrine System Diseases
Fatigue
Fever
Growth Hormone
Headache
Humans
Hypopituitarism
Hypothyroidism
Sleep Initiation and Maintenance Disorders
Weight Loss
Growth Hormone
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