Yasin Hasan BALCIOĞLU, Simge KIRLIOĞLU SEREN, Emine Füsun ÖZDEMİR, Fatih ÖNCÜ

Birincil polidipsi ve bipolar bozukluk birlikteliği: HPA aks disfonksiyonunun işareti olabilir mi?

Birincil polidipsi, artmış susama hissi ve 3 lt/günden fazla sıvı alımı ile karakterize, genellikle psikiyatrik hastalarda rastlanan ve etiyolojisi net olmayan bir durumdur. En fazla eşlik eden psikiyatrik bozukluk şizofreni olarak bildirilmiş olup bipolar bozuklukla birlikteliği nadir olarak gösterilmiştir. Hiponatremiye bağlı konvülziyon, serebral ödem, kardiyak arrest ve koma gibi yaşamsal tehlike oluşturan komplikasyonlara yol açmasından dolayı birincil polidipsinin tanısı ve tedavisi klinik önem taşımaktadır. Bu yazıda, bipolar bozukluğu olan, lityum tedavisi altında halen remisyondaki, beş ay önce başlayan artmış su alımı olan ve tanıya yönelik kapsamlı klinik incelemenin sonucunda polidipsiye yol açabilecek herhangi bir tıbbi durum saptanmayan bir olgu bildirilmiştir. Birincil polidipsinin etiyolojisi belirsizliğini korumakla birlikte, hipotalamik-pitüiter-adrenal (HPA) aks düzensizliğinin bipolar bozukluk ve birincil polidipsiye yol açmasının olası düzenek olabileceği öne sürülmüş ve bu olgu sunumunda iki bozukluğun birlikteliğinde HPA aks düzensizliğinin rol oynayabileceği görüşüne katkı sağlamak amaçlanmış ve tartışılmıştır.

Co-occurrence of primary polydipsia and bipolar disorder: can it be a sign of HPA axis dysfunction?

Primary polydipsia (PP) is an etiologically unclear condition that characterized by increased thirst and excessive fluid intake with greater than 3L per day and which usually is coincided in patients with psychiatric disorders. The most commonly reported psychiatric disorder is schizophrenia; however, bipolar disorder is also infrequently described in concurrence. It is remarkable to note that PP could be life-threatening owing to hyponatremia which may lead seizures, cerebral edema, cardiac arrest and coma; thereby, diagnosing and treating PP are crucial. We report a case with a diagnosis of bipolar disorder, currently on remission with the treatment of lithium, presented with 5month-history of increased water intake. A thorough clinical and diagnostic assessment revealed that patient had not any medical condition which could lead to polydipsia. It is argued that dysregulation of hypothalamic-pituitaryadrenal (HPA) axis could be the underlying reason of affective disorders and the mechanism which may lead to PP. Despite the cause of polydipsia remains unclear, we aimed to provide evidence for the associative role of HPA axis dysfunction in PP comorbid bipolar disorder.

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