Three Cases with Pituitary Adrenocortical Insufficiency Referred to Psychosomatic Medicine, Initially Suspected as Depressive Disorder

Abstract

Adrenocortical insufficiency presents non-specific symptoms including anorexia, nausea/vomiting, fatigue and depressive mood. Here we report three cases whose diagnosis was initially depressive disorder but finally pituitary adrenocortical insufficiency referred to department of psychosomatic medicine. Case 1 : A 59-year-old man was admitted to our hospital with severe nausea, vomiting, depressive mood, and weight reduction. Biochemical examination showed hypoglycemia and hyponatremia. Serum cortisol was 1.03 μg/dl and plasma adrenocorticotropic hormone (ACTH) level was below 5.0 pg/ml. He was definitely diagnosed as isolated ACTH deficiency. Case 2 : A 77-year-old man was hospitalized due to depression and lower back and extremity pain appeared from the death of his dog. Cortisol and ACTH levels were 4.21 μg/dl and 5.7 pg/ml, concomitant with Rathke’s cleft cyst in the brain magnetic resonance imaging. Secondary adrenocortical insufficiency was diagnosed. Case 3 : A 47-year-old man was admitted to our hospital with nausea, vomiting, anorexia, and depressive mood appeared from the Great East Japan Earthquake. Biochemical examination showed normal findings but cortisol was and ACTH levels were cortisol<0.8 μg/dl, ACTH<2.0 pg/ml respectively. He was diagnosed as partial pituitary adrenocortical insufficiency complicated by hyperthyroidism. If a patient presenting non-specific somatic symptom or depression was referred to psychosomatic medicine, it is necessary to examine the adrenocortical function for differential diagnosis.