皮质醇增多症和精神异常

Hypercortisolism and psychosis

目的探讨皮质醇水平变化和精神异常之间的关系。方法将本院确诊的133例皮质醇增多症患者按病因不同分成肾上腺病变组,垂体腺瘤组和异位ACTH肿瘤组,对比分析皮质醇变化和精神异常的关系。结果(1)不同病因引起皮质醇增多的水平和变化幅度差异有统计学意义。(2)高皮质醇血症患者的精神异常主要表现为忧郁、兴奋和其他精神异常。79.7%的患者有抑郁的表现。(3)异位ACTH肿瘤组皮质醇水平和24 h尿游离皮质醇上升幅度较另外两组显著升高(P<0.05),组内患者均有抑郁表现,自杀倾向发生率58.3%,较其他两组显著增多(P<0.01)。结论(1)精神异常不仅和皮质醇浓度有关,还和皮质醇水平的波动幅度关系密切。(2)重视皮质醇增多和精神异常之间的关系,对临床诊断和治疗有重要意义。

Objective To studytherelationshipbetweenhypercortisolismand psychosis. Methods According to pathologic diagnosis, 133 cases of hypercortisolism were dividedinto adrenal lesion group, pituitary adenoma group and ectopic ACTH tumor group, and the relationship between hypercortisolism and psychosis was analyzed. Results (1) There were significant differences between groups regarding cortisol levels and the amplitude of fluctuation. (2) Depression and mania were the main manifestations of psychosis in the patients, and 79.7% of the patients showed symptoms of depression. (3) In ectopic ACTH tumor group, the level and the increased amplitude of 24 h urinary free cortisol were significantly higher than those in the other two groups, all the patients had severe depression, and the rate of suicide tendence (58.3%) was significantly higher than the other two groups. Conclusions (1) Psychosis has a close relationship with hypercortisolism,especially with the marked fluctuation in cortisol level. (2) Sufficient attention should be paid to this relationship, which will improve the diagnosisand treatment of hypercortisolism.