Hyperaldosteronism and bipolar mixed episode: A case report

Introduction: Aldosterone is a steroid hormone produced by the outer section of the adrenal cortex. Both glucocorticoids and mineralocorticoids receptors are present in brain structures (e.g. hippocampus and amygdala) that are involved in behavior such as fear and anxiety. Methods: We report a 54 year old male who was referred from the endocrine ward presented with a dysphoric mood, irritability, insomnia, decreased in appetite, talkativeness, anhedonia, hopelessness, worthlessness, recurrent thought of death, somatic symptoms, which include palpitation and sweating. Mental status examination revealed bipolar 1 disorder, single episode mixed, severe, without psychotic feature based on diagnostic statistical manual of mental disorder (DSM4TR) The aldosterone was high and renin was low. Other clinical examination was normal. Conclusion: The age of onset, no history of mood episodes, atypical feature of this episode and associated hyperaldosteronism suggest the causal role of aldosterone in this episode. The patient was treated with Depakin 500m/d, Quetiapine 50mg/d and Haloperidol 5mg/d. His mental and somatic symptoms improved in 4 weeks. This case can show the relationship between hyperaldosteronism and mood episodes. For future studies, it is decent to do more investigation to find the role of aldosterone in mood regulation. Declaration of Interest: None.