Delirium Associated with Adrenal Insufficiency: A Case Report

腎上腺功能不全相關的譫妄：病例報告

楊俊杰(Chun-Chieh Yang) ； 陳奇祥(Khee-Siang Chan) ； 陳家豪(Chia-Hao Chen) ； 陳欽明(Chin-Ming Chen) ； 楊煦星(His-Hsing Yang)

《中華民國急救加護醫學會雜誌》 16卷1期 (2005/03) Pp. 31-36

https://doi.org/10.30018/JECCM.200503.0005

摘要

譫妄是因瀰漫性或多發性大腦功能失常而表現出急性且變化的意識混亂狀態。譫妄的臨床表現包括精神狀態、注意力不集中、思考錯亂、定向力喪失、感覺及知覺能力等快速的變化。譫妄的重要徵像則是意識狀態之變化。有許多且不同的疾病會引起譫妄，事實上病患所面對任何醫療狀況上的變化都有可能誘發譫妄之發生。這些醫療狀況包括體液和電解質的不平衡、感染、藥物中毒、代謝性疾病、血液灌流不足及酒精和鎮靜劑戒斷等。本病例報告為一位58歲男性接受冠狀動脈繞道手術後併發急性縱膈炎及菌血症而出現譫妄，病患的譫妄在感染已獲得控制後仍舊持續惡化，而一系列腎上腺皮質素濃度的追蹤顯上腺功能不全。經由低劑量類固醇治療，病患的譫妄3天後完全改善。總之，譫妄的治療重點在於控制或矯正根本疾病。

關鍵字

譫妄 ； 腎上腺功能不全

並列摘要

Delirium is an acute, fluctuating state of confusion resulting from diffuse or multifocal cerebral dysfunction.
Delirium involves a rapid alternation in mental status, attention disruption, disorganized thinking, disorientation, changes in sensation and perception, and other symptoms. The hallmark of delirium is a fluctuating level of consciousness. Disorders that cause delirium are numerous and varied. Virtually any medical conditions can precipitate delirium in a susceptible person and multiple underlying disorders are often found. Such conditions include fluid and electrolyte imbalance, infections, drug toxicity, metabolic disorders, low perfusion states and withdrawal from alcohol and/or sedatives. We report on a 58-year-old patient who developed delirium after coronary artery bypass grafting complicated with acute mediastinitis and septicemia postoperatively. His delirium continued to progress even after the infection was brought under control and a series of random cortisol level checks revealed adrenal insufficiency. He received steroid therapy with prednisolone 5mg bid and his delirium markedly improved three days later. In conclusion, the principal treatment for delirium is to control or reverse the underlying disorders.

並列關鍵字

delirium ； adrenal insufficiency