Cybermedicine.
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Biomedical subjects
Publications and source records attributed to R Pies.
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The differential diagnosis of hypercortisolemia is complex, particularly when the clinician must distinguish Cushing's syndrome (CS) from major depression. The present clinical case history demonstrates that by means of physical and laboratory examinations, the psychiatrist can make the initial differentiation, in consultation with medical specialists. The use of the corticotropin-releasing factor (CRF) stimulation test may be especially helpful in distinguishing Cushing's disease (CD) from major depression, though there is some degree of "overlap" in results. This suggests that these disorders may lie along a continuum of hypothalamopituitary dysfunction.
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Symptoms of so-called atypical depression, such as hypersomnia and lethargy, may accompany specific sleep disorders. It is often difficult to determine which disorder is "primary". The authors examine three cases of depression with atypical features associated with specific sleep disorders and report a favorable response to valproate. Some clinical features of the cases suggest a primary sleep disorder with secondary affective symptoms. However, valproate may have direct mood-altering effects as well as effects on sleep physiology. The implications of these findings for diagnosis and treatment are discussed.
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