Cannabis-Hyperemesis-Syndrom

Zusammenfassung

Vorgestellt wird der Verlauf einer am ehesten durch Cannabis hervorgerufenen zyklischen Hyperemesis bei einer cannabisabhängigen, aber sonst gesunden jungen Frau. Die zyklische Hyperemesis entwickelte sich im zeitlichen Zusammenhang mit einem vermehrten Cannabiskonsum und remittierte komplett innerhalb weniger Tage in einer beschützten abstinenten Umgebung. Genauso wie die zunehmend in der Literatur berichteten Fälle besserte sich die Hyperemesis durch heißes Duschen oder Baden. Diese Thermosensitivität in Kombination mit den hier erstmals gefundenen laborchemischen Hinweisen auf eine zeitgleiche reversible zentrale Hyperthyreose lassen an eine Beteiligung des hypothalamischen Cannabinoidsystems an der zyklischen Hyperemesis denken. Auch während einer gut 4-monatigen ambulanten Nachsorge trat bei kontrollierter Cannabisabstinenz kein Erbrechen mehr auf.

Abstract

We present the course of cyclical hyperemesis most likely induced by cannabis in a young cannabis-dependent, but otherwise healthy female adult. Cyclical hyperemesis developed in parallel to increasing cannabis inhalation, and remitted completely within a few days of abstinence in a protective inpatient setting. Just as in those increasing cases which can be found in literature, the hyperemesis improved by taking a hot shower or bath at the beginning of the detoxification. This thermosensitivity, along with the detection of a central disturbance of the thyroid axis, points to the hypothalamic cannabinoid system being involved in cannabis-induced cyclical hyperemesis. The patient was followed up for 4 months without any re-occurrence of the syndrome during controlled cannabis abstinence.

Schlüsselwörter

Cannabis - zyklische Hyperemesis - Hypothalamus - zentrale Hyperthyreose

Keywords

cannabis - cyclical hyperemesis - hypothalamus - central hyperthyroidism

Literatur

• 1 Talley N J. Functional nausea and vomiting.  Aust Fam Physician. 2007;  36 694-697
• 2 Sullivan S. Cannabinoid hyperemesis.  Can J Gastroenterol. 2010;  24 284-285
• 3 Allen J H, Moore G M, Twartz J C. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse.  Gut. 2004;  53 1566-1570
• 4 Wallace de D, Martin A L, Park B. Cannabinoid hyperemesis: marijuana puts patients in hot water.  Australas Psychiatry. 2007;  15 156-158
• 5 Moore G M. Value of the single case report. Marijuana, vomiting and compulsive bathing: a new clinical syndrome?.  Aust N Z J Psychiatry. 2005;  39 1046
• 6 Watts de M. Cannabinoid hyperemesis presenting to a New Zealand hospital.  NZ Med J. 2009;  122 116-118
• 7 Boeckxstaens G E. Cannabinoid hyperemesis with the unusual symptom of compulsive bathing.  Ned Tijdschr GeneeskdNed. 2005;  149 1468-1471
• 8 Alfonso M oreno V, Ojesa F, Moreno-Osset E. Cannabinoid hyperemesis.  Gastroenterol Hepatol. 2006;  29 434-435
• 9 Ochoa-Mangado E, Jiménez Giménez M, Salvador Vadillo E et al. Cyclical hyperemesis secondary to cannabis abuse.  Gastroenterol Hepatol. 2009;  32 406-409
• 10 Budhraja V, Narang T, Azeez S. Cannabinoid hyperemesis syndrome: cyclic vomiting, chronic cannabis use, and compulsive bathing.  Pract Gastroenterol. 2008;  32 78-80
• 11 Chepyala P, Olden K W. Cyclic vomiting and compulsive bathing with chronic cannabis abuse.  Clin Gastroenterol Hepatol. 2008;  6 710-12
• 12 Chang Y E, Windish D M. Cannabinoid hyperemesis.  Mayo Clin Proc. 2009;  84 76-78
• 13 Donnino M W, Cocchi M N, Miller J et al. Cannabinoid hyperemesis: A case series.  J Emerg Med. 2009;  [Epub ahead of print]
• 14 Sontineni P, Chaudhary S, Sontineni V et al. Cannabinoid hyperemesis syndrome: clinical diagnosis of an unrecognised manifestation of chronic cannabis abuse.  World J Gastroent. 2009;  15 1264-1266
• 15 Soriano-Co M, Batke M, Cappell M S. The Cannabis Hyperemesis Syndrome Characterized by Persistent Nausea and Vomiting, Abdominal Pain, and Compulsive Bathing Associated with Chronic Marijuana Use: A Report of Eight Cases in the United States.  Dig Dis Sci. 2010;  55 3113-119
• 16 Pijlman F TA, Rigter S M, Hoek J et al. Strong increase in total delta-THC in cannabis preparations sold in Dutch coffee shops.  Addict Biol. 2005;  10 171-180
• 17 EMCDDA .Annual report 2010: the state of the drugs problem in Europe: Cannabis. http://www.emcdda.europa.eu/online/annual-report/2010/cannabis/2
• 18 Budney A J, Novy P L, Hughes J R. Marijuana withdrawal among adults seeking treatment for marijuana dependence.  Addiction. 1999;  94 1311-1321
• 19 Bonnet U, Scherbaum N. Cannabis use disorders. Part I: Pharmacology, Epidemiology and Therapy.  Fortschr Neurol Psychiat. 2010;  78 297-304
• 20 Wargo K A, Geveden B, McConnell V J. Cannabinoid-induced pancreatitis: a case series.  JOP. 2007;  8 579-583
• 21 Hamilton M. The assessment of anxiety states by rating.  Brit J Med Psychol. 1959;  32 50-55
• 22 Hamilton M. A rating scale for depression.  J Neurol Neurochirurg Psychiat. 1960;  23 56-62
• 23 Grauwiler S B, Drewe J, Scholer A. Sensitivity and specifity of urinary cannabinoid detection with two immunoassays after controlled oral administration of delta-9-tetrahydrocannabinol to humans.  Ther Drug Monit. 2008;  30 1114-1124
• 24 Roca R P, Blackmann M R, Ackerly M B et al. Thyroid hormone elevations during acute psychiatric illness: relationship to severity and distinction from hyperthyroidism.  Endocr Res. 1990;  16 415-447
• 25 Arem R, Cusi K. Thyroid function testing in psychiatric illness. Usefulness limitations.  Trends Endocrinol Metab. 1997;  8 282-287
• 26 Bonnet U, Scherbaum N. Cannabis use disorders. Part II: Psychiatric and somatic sequelae and comorbidities.  Fortschr Neurol Psychiat. 2010;  78 360-370
• 27 Machado Rocha F C, Stéfano S C, De Cássia Haiek R et al. Therapeutic use of Cannabis sativa on chemotherapy-induced nausea and vomiting among cancer patients: systematic review and meta-analysis.  Eur J Cancer Care. 2008;  17 431-443
• 28 Cota D, Steiner M A, Marsicano G et al. Requirement of cannabinoid receptor type 1 for the basal modulation of hypothalamic-pituitary-adrenal axis.  Endocrinology. 2007;  148 1574-81
• 29 Benarroch E E. Thermoregulation: recent concepts and remaining questions.  Neurology. 2007;  69 1293-1297
• 30 Steiner M A, Wotjak C T. Role of the endocannabinoid system in regulation of the hypothalamic-pituitary-adrenocortical axis.  Prog Brain Res. 2008;  170 397-432
• 31 Brown T T, Dobs A S. Endocrine effects of marijuana.  J Clin Pharmacol. 2002;  42 (Suppl 1) 90S-96S
• 32 Wenger T, Moldrich G. The role of endocannabinoids in the hypothalamic regulation of visceral function.  Leukot Essent Fatty Acids. 2002;  66 301-330
• 33 Glass M, Dragunow M, Faull R LM. Cannabinoid receptors in the human brain: a detailed anatomical and quantitative autoradiographic study in the fetal, neonatal and adult human brain.  Neuroscience. 1997;  77 299-318
• 34 Shelke A R, Mustian K M, Morrow G R. The pathophysiology of treatment-related nausea and vomiting in cancer patients: current models.  Indian J Physiol Pharmacol. 2004;  48 256-268
• 35 Baker P D, Morzorati S L, Ellet M L. The pathophysiology of chemotherapy-induced nausea and vomiting.  Gastroenterol Nurs. 2005;  28 469-480
• 36 Aviello G, Romano B, Izzo A A. Cannabinoids and gastrointestinal motility: animal and human studies.  Eur Rev Med Pharmacol Sci. 2008;  12 (Suppl 1) 81-93
• 37 Maywood E S, O’Neill J, Wong G K et al. Circadian timing in health and disease.  Prog Brain Res. 2006;  153 253-269
• 38 Acuna-Goycolea C, Obrietan K, Pol A N. Cannabinoids excite circadian clock neurons.  J Neurosci. 2010;  30 10061-10066
• 39 Vaziri N D, Thomas van den R, Sterling M et al. Toxicity with intraveneous injection of crude marijuana extract.  Clin Toxicol. 1981;  18 353-366
• 40 Smith P F, Ashton J C, Darlington C L. The endocannabinoid system: a new player in the neurochemical control of vestibular function?.  Audiol Neurotol. 2006;  11 207-212
• 41 Morrow G R, Roscoe J A, Hickok J T et al. Nausea and emesis: evidence for a biobehavioral perspective.  Support Care Cancer. 2002;  10 96-105