Escolar Documentos
Profissional Documentos
Cultura Documentos
Brief Article
Abstract
Introduction: Aldosterone is a steroid hormone produced by the outer section of the adrenal cortex.
Both glucocorticoids and mineralocorticoids receptors are present in brain structures (e.g.
hippocampus and amygdala) that are involved in behavior such as fear and anxiety.
Methods: We report a 54 year old male who was referred from the endocrine ward presented with a
dysphoric mood, irritability, insomnia, decreased in appetite, talkativeness, anhedonia,
hopelessness, worthlessness, recurrent thought of death, somatic symptoms, which include
palpitation and sweating.
Mental status examination revealed bipolar 1 disorder, single episode mixed, severe, without
psychotic feature based on diagnostic statistical manual of mental disorder (DSM4TR)
The aldosterone was high and renin was low. Other clinical examination was normal.
Conclusion: The age of onset, no history of mood episodes, atypical feature of this episode and
associated hyperaldosteronism suggest the causal role of aldosterone in this episode.
The patient was treated with Depakin 500m/d, Quetiapine 50mg/d and Haloperidol 5mg/d.
His mental and somatic symptoms improved in 4 weeks.
This case can show the relationship between hyperaldosteronism and mood episodes.
For future studies, it is decent to do more investigation to find the role of aldosterone in mood
regulation.
Declaration of Interest: None.
Keywords: Hyperaldosteronism, Bipolar mood disorder, mixed episode
Introduction
International Journal of Applied Behavioral Sciences (IJABS) volume 2 number 1 Spring 2015. Journals. smbu.ac.ir/ijabs
41
Case report
A 54 year old male was admitted to the
endocrine ward and referred to our hospital for
psychiatric consult due to symptoms of
malaise, dysphoric mood, irritability, insomnia,
loss of appetite, increasing the amount of
speech, lack of enjoyment of life, hopelessness,
thoughts of worthlessness, and thoughts of
death. These symptoms were started from 4
months ago, after change in his career. Other
symptoms such as sweating and palpitations
were seen as well. According to DSM4TR
criteria, he was admitted in the psychiatric
ward with diagnosis of bipolar disorder single
mixed episode, severe, without psychotic
feature.
There was no history of mood episodes in this
patient. He had a history of cigarette smoking
42
Conclusion
Since sodium ions have an important role in
action potentials of neurons, so, increased
levels of aldosterone can be made by increasing
the sodium ion level, which can cause nerve
cell excitability (4). The mineralocorticoid
receptor changes in the brain such as the
hippocampus and amygdala, which could be a
result of changes in aldosterone level, and
could account for changes in mood and anxiety
levels (5-15).
In this case, according to symptoms in upper
age with no previous history of mood disorder,
atypical and mixed manifestations with
increased aldosterone level can be discussed.
Studies by Hlavacova and Gripo in 2008 and
2006 presented that the result of stress can be
created by increasing the aldosterone
exacerbation cycle (10, 15).
In a study by Handler et al. and sonio et al. in
2006 and 1975 demonstrated that an increase in
aldosterone can change the mood in depression
and anxiety in manic patients. In these studies,
obsessive and panic irritable mood had been
noted, but the present patient presented mixed
episodes, and irritability (7, 11).
In a study in 2014 by Apostopoulou indicated
that women are more affected of aldosterone
level than men, but mixed episode are usually
more common in women than man (9).
Therefore, this presentation in this patients can
be seen as a result of patient's endocrine
etiology.
In a study by kunzel in 2012, more improve in
physical symptoms than anxiety and depression
symptoms were noted (6), so in our patients,
International Journal of Applied Behavioral Sciences (IJABS) volume 2 number 1 Spring 2015. Journals. smbu.ac.ir/ijabs
Hashempour, Arbabi
Acknowledgment
We would like to thank to our colleagues and
the organizations for all provided insight and
expertise that greatly assisted this research and
patients who helped us kindly in the project.
We also tried to consider all ethical issues in
this study.
References
1. Marieb Human Anatomy & Physiology 9th edition,
chapter:16, page:629, question number:14
2. Conn JW, Louis LH. Primary aldosteronism: a new
clinical entity. Transactions of the Association of
American Physicians.1955, 68: 21531;
3. Selye H. Stress and disease. Science. 1955; 122
(3171):625631.
4. Barnett MW, Larkman PM."The action potential".
Practical Neurology. 2007, 7 (3): 1927.
5. Korte SM. Corticosteroids in relation to fear, anxiety
and
psychopathology.
Neuroscience
and
biobehavioral reviews. 2001; 25 (2):117142.
6. Knzel h. Anxiety and depressive symptoms in
patients with primary aldosteronism in a longitudinal
study. Endocrine Abstracts. 2012; 29 .74-78
7. Sonino N, Fallo F, et al. Psychological aspects of
primary
aldosteronism.
Psychotherapy
and
psychosomatics. 2006;75 (5):327
8. Hlavacova N, Wes P, Ondrejcakova M, Subchronic
treatment with aldosterone induces depression-like
behaviours and gene expression changes relevant to
major depressive disorder. International Journal of
Neuro psychopharmacology. 2012; 15, 247265
9. Apostolopoulou k. gender differences in anxiety and
depressive symptoms in patients with primary
hyperaldosteronism: a cross sectional study. The
world journal of biological psychiatry. 2014;
15(1):26-35.
10. Hlavacova N, Jezova D. Chronic treatment with the
mineralocorticoid hormone aldosterone results in
increased anxiety-like behavior. Hormones and
behavior. 2008;54 (1):9097
International Journal of Applied Behavioral Sciences (IJABS) volume 2 number 1 Spring 2015. Journals. smbu.ac.ir/ijabs
43