脳動脈瘤クリッピング術後に血漿コルチゾール高値を伴うせん妄を認めた1例

Abstract

The effects of cortisol on psychiatric symptoms (feeling, sleep, attention, memory, and so on) have been well known in the psychiatric field. We report a case of delirium with hypercorticoidism after aneurysmal clipping. The 74-year-old male who had been treated with synthetic estrogen for 3 years demonstrated psychiatric symptoms, which consisted of disorientation, memory disturbance, delusion of observation, depres- sive state with markedly high cortisol level in plasma (115.4μg/dl) following clipping of cerebral aneurysm. When synthetic estrogen (fosfesrol, 400mg/day) that he had received was discontinued and he was treated with haloperidol (1.5mg/day), the mental symptoms showed a marked improvement. In this case, we found that long-term administration of synthetic estrogen had caused prolonged delirium in the patient and that exogenous effect (brain surgical invasion) with synthetic estrogen had caused the specifically elevated plasma cortisol level. It was suggested that for patients who received steroid therapy of long duration there is a need to monitor plasma cortisol levels and carry out careful observation for the occurrence of psychiatric symptoms.