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Mania in association with hydrocortisone replacement for Addison's disease
E Ur1, T H Turner, T J Goodwin
1Department of Endocrinology, St Bartholomew's Hospital, London, UK.
Postgraduate Medical Journal
|January 1, 1992
Summary
A woman with adrenal insufficiency experienced depression, then mania after glucocorticoid treatment. This suggests prolonged low cortisol may increase brain sensitivity to corticosteroids, triggering mood disorders.
Area of Science:
- Neuroendocrinology
- Psychiatry
- Endocrinology
Background:
- Untreated primary adrenocortical insufficiency is characterized by hypocortisolism.
- Depressive symptoms are common in patients with adrenal insufficiency.
- Glucocorticoids are crucial for mood regulation.
Observation:
- A 32-year-old woman with untreated primary adrenocortical insufficiency presented with severe depressive symptoms.
- Following treatment with physiological doses of glucocorticoids, she developed a self-limiting acute manic episode.
- This case highlights a potential link between adrenal function and mood disorders.
Findings:
- The patient's prolonged hypocortisolism may have led to the up-regulation of hippocampal glucocorticoid receptors.
- This up-regulation could have resulted in increased cerebral sensitivity to exogenous corticosteroids.
- Exogenous corticosteroids, even at physiological doses, may precipitate manic symptoms in susceptible individuals.
Implications:
- This case suggests a mechanism by which adrenal insufficiency and its treatment can influence mood.
- Understanding glucocorticoid receptor sensitivity is crucial for managing psychiatric comorbidities in endocrine disorders.
- Further research is warranted to explore the neurobiological underpinnings of mood disturbances in adrenal insufficiency.