肢端肥大症患者总是表现出广泛的临床表现,包括典型的身体变化,如肢和面部特征,以及不典型的神经精神和心理障碍。然而,对于伴有精神病合并症的肢端肥大症患者的治疗仍缺乏临床指导。因此,我们分享这一病例,为临床医生管理有精神症状的肢端肥大症患者提供参考。该病例报告描述了一名41岁的男性,由于分泌生长激素的垂体腺瘤而有8年的肢端肥大症病史。垂体磁共振成像(MRI)显示的最大横截面积为42mm×37mm.患者接受保守药物治疗,每月定期注射SandostatinLAR10mg。入院前两天,他突然出现了急性精神病发作。除了典型的肢端肥大症相关的变化,他的主要临床表现是嗅觉/听觉幻觉,参考/迫害妄想,不稳定的情绪和冲动的行为。考虑到精神分裂症样精神病和病程特征,根据精神疾病诊断和统计手册,他被诊断出患有短暂的精神病,第5版(DSM-5)经过多学科咨询和评估。他开了阿立哌唑处方,锥体外系症状较少,对催乳素升高的影响最小,每天5毫克的剂量来控制精神症状,他的反应很好。在出院时和2个月后的随访中,患者病情稳定,无任何精神病性症状复发.出院后1周生长激素(GH)和胰岛素样生长因子1(IGF-1)水平分别为2.22ng/mL[正常范围(0-2.47ng/mL)]和381μg/L[正常范围(94-284μg/L)],分别,与精神病发作前的情况相似。该报告的结果进一步证明,小剂量阿立哌唑对激素水平和垂体大腺瘤的发展几乎没有影响。这个特殊的案例强调了临床医生掌握和仔细识别与肢端肥大症相关的精神障碍的可能症状的重要性,并强调需要进一步研究更有效的治疗肢端肥大症合并精神病的策略.
Acromegalic patients always demonstrate a wide range of clinic manifestations, including typical physical changes such as acral and facial features, as well as untypical neuropsychiatric and psychological disturbances. However, there is still a lack of clinical guidance on the treatment for acromegalic patients with psychiatric comorbidities. We therefore share this
case to provide a reference for clinicians to manage the acromegalic patients with psychiatric symptoms. This
case report describes a 41-year-old male with an 8-year history of acromegaly due to growth hormone-secreting pituitary adenoma, the maximum cross-sectional area of which was 42 mm × 37 mm demonstrated by pituitary magnetic resonance imaging (MRI). The patient received conservative medicine treatment by regularly injecting with Sandostatin LAR 10 mg per month. Two days before admission, he suddenly presented with an acute psychotic episode. In addition to the typical acromegaly-associated changes, his main clinical presentations were olfactory/auditory hallucinations, reference/persecutory delusions, instable emotion and impulsive behavior. Considering the schizophrenic-like psychoses and course features, he was diagnosed with Brief Psychotic Disorder according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) after a multidisciplinary consultation and evaluation. He was prescribed Aripiprazole, which had less extrapyramidal symptoms and minimal influence on prolactin elevation, with the dose of 5 mg per day to control the psychiatric symptoms and he responded quite well. At the time of discharge and the follow-up 2 month later, the patient was stable without recurrence of any psychotic symptoms. The levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) 1 week after discharge were 2.22 ng/mL [normal range (0-2.47 ng/mL)] and 381 μg/L [normal range (94-284 μg/L)], respectively, which were similar to those before the psychotic episode. Results from this report further supported that small dose of Aripiprazole had little influence on hormonal levels and the development of pituitary macroadenoma. This particular
case emphasizes the importance for the clinician to master and carefully identify the possible symptoms of mental disorders associated with acromegaly, and also highlights the need for further investigation in more efficient treatment strategies for acromegalic cases with psychiatric comorbidities.