Hipopituitarizam uzrokovan zloporabom kortikosteroida – prikaz bolesnika

Jana Jelčić, Dina Jović, Tomo Lucijanić, Branka Aukst Margetić

Hipopituitarizam je stanje u kojem je prednji režanj hipofize insuficijentan te se posljedično javljaju deficijencije hormona koje ona proizvodi. Osobe s hipopituitarizmom koje ne uzimaju nadomjesnu terapiju mogu razviti adrenalnu krizu, životno ugrožavajuće stanje koje za neke pacijente može biti traumatično i izazvati abnormalan strah od smrti. Prikazujemo 37-godišnjeg pacijenta s hipopituitarizmom koji je posljedično razvio panični poremećaj s agorafobijom. Od 19. godine boluje od Hashimoto tireoiditisa. Zaposlen u hitnoj službi, godinama je radio po noći, a po danu pokušavao studirati. Zbog nezadovoljstva izgledom krenuo je u teretanu i uzimao anaboličke steroide. Preveliko opterećenje vježbanjem dovelo je do bolova u leđima liječenih injekcijama ketoprofena, metilprednizolona i diazepama. Budući da je zdravstveni radnik, nastavio je tijekom pet godina redovito sam sebi aplicirati injekcije metilprednizolona. Tijekom obrade novonastale erektilne disfunkcije utvrđen je manjak testosterona, hormona rasta i kortizola te je dijagnosticiran idiopatski panhipopituitarizam jer je zatajio samostalno uzimanje steroida. Zbog neredovitog uzimanja nadomjesne terapije razvio je adrenalnu krizu, nakon čega se javljaju panični napadaji, što ga je potaknulo da prizna prijašnju zloporabu. Od tada je u redovitom praćenju endokrinologa uz postupno snižavanje doze hidrokortizona i testosterona. Započet je farmakoterapijski i psihoterapijski tretman te je uveden vortioksetin postupno do doze 20 mg na dan uz alprazolam 1,5 mg na dan, te se psihičke smetnje u potpunosti povlače. Prati se poboljšanje općeg stanja. Hipopituitarizam može biti praćen i psihijatrijskim smetnjama, a ovaj slučaj ukazuje na značaj uzimanja psihoaktivnih tvari kao uzroka hipopituitarizma kod idiopatskih slučajeva.

Hypopituitarism is a condition in which the anterior pituitary lobe is insufficient, leading to hormone deficiencies. Individuals with hypopituitarism who do not receive replacement therapy may experience an adrenal crisis, a life-threatening condition that can be traumatic for some patients and trigger panic and abnormal fear of death. We present a 37-year-old male patient who developed hypopituitarism and consequently panic attacks and agoraphobia. He was diagnosed with Hashimoto’s thyroiditis at the age of 19. The patient has worked night shifts in the emergency department while attempting to attend the university during the day. Dissatisfied with his appearance, he started weight training and using testosterone. Excessive exercise caused back pain, treated with injections of ketoprofen, methylprednisolone and diazepam. Employed in the emergency department, he began self-administering methylprednisolone injections. During the work-up for erectile dysfunction, he was found to have deficiencies in testosterone, growth hormone, and cortisol. Since he concealed his steroid use, idiopathic panhypopituitarism was diagnosed. Irregular adherence to therapy led to an adrenal crisis. This triggered several panic attacks, which prompted him to admit previous abuse. He is now under regular endocrinological follow-up with gradual dose reduction of hydrocortisone and testosterone. Psychiatric treatment, including pharmacotherapy and psychotherapy was started, vortioxetine up to 20 mg/day and alprazolam up to 1.5 mg/day were prescribed, and remission of psychiatric symptoms was achieved. His overall condition is improving. Hypopituitarism can be followed by psychiatric issues, and psychiatric problems can be associated with the abuse of psychoactive substances, which should be considered in idiopathic cases.